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OUTLINES 



OF 



Clinical Diagnostics 



OF THE 



Internal Diseases of Domestic Animals 



BY 



Prof. Dr. Bernard Malkmus 

Professor of Theory and Practice and Director of the Clinic 

for Internal Diseases at the Royal Veterinary 

College of Hanover, Germany 

SECOND EDITION— REVISED AND ENLARGED 



Translated from the Latest, Revised German Edition by 

David S. White, Dean of the College of Veterinary 

Medicine, Ohio State University and Dr. Paul 

Fischer, State Veterinarian of Ohio 



CHICAGO 

ALEX EGER 

1908 












A 



LIBRARY of CONGRESS 
I we Copies rtecei«e« 

JUN 29. 1908 

faJb 7 !<*'* 

0t,A&fe4 XXft Nu. 



COPYRIGHTED AT 

WASHINGTON, D. C, 

BY ALEX. EGER 

1908 



Authorized Translation 

Translator's Preface. 



IN the translation of Malknrus' "Grundriss der Klinischen 
Diagnostik" we have endeavored simply to reproduce 
the author's ideas with the hope that the English and 
American Veterinary Students may thus be provided with 
a text-book for which they have long felt a need. The 
needs of the students in the College of Veterinary Medi- 
cine of the Ohio State University have been the direct 
cause of the hurried undertaking of this work. A few short 
notes which we thought proper to add here and there, 
throughout the book, have been placed in [ ]. 

Columbus, O., David S. White, 

January, 1908. Paul Fischer. 



Preface to the Third Edition. 



THE favorable reception which this work has met is 
emphasized by the fact that it has been translated into 
both the English and French languages. I am convinced 
that the concise manner in which I have presented the 
subject of clinical diagnostics has received friendly recog- 
nition from practitioners. In re-writing the third edition 
I have endeavored to include everything which would con- 
tribute toward making it more complete and better. To 
this end all recent clinical observations and new methods 
of examination have been employed. Tbe number of illustra- 
tions has been increased ; and a table in color of the quanti- 
tative determination of indican has been added. 

Hanover, April, 190G. Mu.kmcs. 



Preface. 



P^HE only safe foundation for the treatment of animal 
* diseases is a correct diagnosis of the malady. In 
therapeutic as well as in forensic veterinary medicine 
everything depends on a correct recognition of the disease. 
This is the most difficult part of veterinary medicine, and 
methodical training alone will enable the student to de- 
velop into a practicing veterinarian who can do justice to 
this demand. 

The following little work which offers a great variety 
of material in a most condensed form is intended as a 
guide for the diagnostician in recognizing and understand- 
ing the symptoms of disease. Although it represents the 
result not only of personal, but of veterinary experience- 
in general, for the sake of clearness and general appearance 
the names of the numerous authors have been omitted.. 
The results of bacteriological research which have an im- 
portant bearing on diagnostics have been given due prom- 
inence. I have also deemed it appropriate to call attention, 
at the proper places, to those diseases or conditions which 
are considered as factors in annulling, or setting aside a 
sale. It was necessary to append a brief description of the 
most common diseases in order to give the student a gen- 
eral idea of the character of the maladies that affect the 
various functional apparatus, thus refreshing his memory 
and enabling him to institute comparisons between what 
he learns from his lectures and sees in the clinic. 

The true to life representations of the horse and cow, 
which are copied from the "Handbuch der Anatomie der 
Thiere fur Kunstler," I owe to the kindness of Prof. Dr.. 
Ellenberger and Prof. Dr. Baum of Dresden. I here most 
kindly thank these gentlemen for their unselfish obliging- 
ness. 

The publishing house of Gebriider Janecke have dis- 
regarded both expense and trouble in order to supply good 
illustrations and to give the book a neat appearance ; to 
them, too, my gratitude is due. 

Hanover, November, 1898. Malkmus. 



Table of Contents. 



PAGE 

The Diagnosis of Diseases 11 

Symptoms 12 

Determining the Diseased Organ 14 

The Recognition of the Disease 15 

I. Anamnesis 18 

II. Determining the Status Praesens 21 

Method of Examination. 

Inspection 21 

Palpation 23 

Percussion 24 

Auscultation 29 

A. General Part of Examination 31 

1. Signalment 31 

2. Habitus 32 

I. Attitude of the Patient 33 

II. Condition 38 

III. Conformation 39 

IV. Temperament 40 

Diseases which are character- 
ized particularly by change 

in Habitus 41 

3. The Skin 43 

I. Condition of the Hair Coat 43 

II. The Skin's Moisture 44 

III. Color of the Skin 45 

IV. Condition of the Skin . 46 

V. Swellings in, and immediately under, 

the" Skin 47 

Diseases of the Skin 49 



VIII 

4. Examination of the Conjunctiva 57 

I. Discharge from the Eyelids 59 

II. Color 59 

5. Bodily Temperature 62 

I. The Normal Temperature 64 

II. Temperature of the Skin 65 

III. Fever 65 

IV. Subnormal Temperature 70 

General Infectious Diseases... 70 

B. Special Part of the Examination. 73 

6. Circulatory Apparatus 73 

I. Pulse 73 

II. Examination of the Peripheral Blood 

Vessels 79 

III. The Heart. 81 

Diseases of the Circulatory Ap- 
paratus 88 

7. Respiratory Apparatus 90 

I. The Respiratory Movements 91 

II. The Breath 100 

III. Nasal Discharge 102 

IV. The Nasal Cavities and Adjacent 

Sinuses 106 

V. Examination of the Submaxillary 

Lvmph Glands 109 

VI. Cough ' Ill 

VII. The Voice 115 

VIII. The Larynx and Trachea 115 

IX. Percussion of the Thorax 118 

X. Auscultation of the Lungs 124 

Diseases of the Respiratory 

Apparatus 129 

8. Digestive Apparatus ' 133 

I. Food and Drink 134 

II. The Buccal Cavity 139 

III. The Throat and Esophagus 142 

IV. Rumination 143 

V. Vomiting 144 

VI. The Abdomen 145 



IX 

VII. The Intestinal Evacuations 156 

Diseases of the Digestive Ap- 
paratus 163 

9. Urinary Apparatus 167 

I. Manner of Voiding the Urine 168 

II. Examination of the Urine 170 

A. Macroscopical Examination . . . 170 

B. Chemical Examination 173 

C. Microscopical Examination. 

A. Crystalline Constituents of 

Urine 184 

B. Organized Elements of Urine. . 186 
III. Examination of the Urinary Organs 189 

Diseases of the Urinary Appa- 
ratus 191 

10. The Sexual Apparatus 192 

I. Abnormally Increased Sexual Appe- 
tite 192 

II. The- Vulva 193 

III. The Vaginal Mucous Membrane... 194 

IV. The Udder 194 

V. Diseases of the Male Sexual Organs 196 

Diseases of the Sexual Organs 196 

11. The Nervous System 197 

I. Psvchic Functions 109 

II. Sensibility 201 

III. Motility -2112 

Diseases of the Nervous System 21 1 1 

C. Specific Examinations. 209 

12. Body Movements 209 

I. Examination for Immobility 209 

II. Examination for Heaves 212 

III. Examination for Roaring 21 I 

IV. Examination for Epilepsy and Ver- 
tigo .'. " 216 

V. Examination for Balkiness 217 



13. Diagnostic Inoculation 218 

I. Tuberculosis 219 

II. Glanders 222 

III. Anthrax, Blackleg, Malignant Ed- 

ema and Wild-und Rinder-Seuche 226 

IV. Rabies - 227 

14. The Lymphatic Glands 229 

15. The Blood 231 

Diseases of the Blood 235 



The Diagnosis of Diseases. 

The object of practical veterinary medicine is manifold, 
but in the main it consists in the restoration of the destroyed 
health of our domestic animals. For this purpose a knowledge 
of the affected organ and of the character of the disease is 
indispensable, because this knowledge offers the only safe basis 
for a rational treatment and a correct prognosis. 

Thus the art of making a correct diagnosis is not only the 
foundation upon which practical veterinary medicine rests, but 
it is pre-eminently that which elevates medicine to the dignity 
of a science. 

Diagnosis is the art of determining in- 
ternal changes of the body by the aid of 
externally visible or otherwise appreci- 
able changes in the animal's condition 
or some of its organs. It also includes 
the recognition and name of the disease. 

Since disease is a deviation from normal conditions and 
physiological processes, morbid changes cannot be recognized 
without a knowledge of normal conditions. 

In the classroom the student has no opportunity to study 
the physical characteristics and the physiological functions of 
organs in living animals ; he must learn this from personal ob- 
servation and investigation in the clinic. In the clinic he 
must cultivate his senses and learn to hear, see, feel and smell 
in order to be able to judge correctly. 

In the course of his practice different species of animals 
are presented to the veterinarian for clinical examination. This 
gives rise to certain difficulties which, in the main, are based 



12 CLINICAL DIAGNOSTICS. 

on differences in anatomical structure and physiological func- 
tion of the organs of different animals. The methods of ex- 
amination are about the same for all species. One who has 
thoroughly learned the fundamental principles underlying the 
methods for the proper examination of a horse will have little 
trouble in adapting them to other animals. However, import- 
ant differences in this respect will receive due consideration. 

A further considerable difficulty in diagnostics, for the 
veterinarian, is his inability to determine the subjective feel- 
ing of a patient. Still, this is of less importance than the 
layman usually supposes. On the other hand, to compensate 
for this, we are in a position, in all cases, to make a complete 
objective examination of the patient in any direction. In this 
respect we have an advantage over the physician who is fre- 
quently denied this privilege and is, besides, liable to be misled 
by the imagination, whim, shame or vanity of the patient. 

A diagnosis consists in the determination of 

1. The symptoms of the disease. 

2. The diseased organ. 

3. The character of the disease — its 
n a m e . 

A Symptom is any observable deviation from the nor- 
mal state or condition. Anatomy and physiology treat of the 
normal conditions and functions ; Symptomatology treats of 
morbid conditions and of perverted functions. 

The particular object of a clinical examination is the de- 
termination of symptoms; it must therefore include the exter- 
nal appearance and general behavior of the animal as well as a 
careful inspection* of every accessible organ. To avoid mistakes 
or overlooking important factors we must conduct this exami- 
nation according to a definite plan. 

The best plan to follow is to take up the different func- 
tional apparatus in their physiological order and complete the 
examination of each in its turn. The beginner should memo- 
rize the scheme and follow it faithfully. This is no difficult 



DIAGNOSIS OF DISEASES. 13 

task since the arrangement is a physiological and therefore 
natural one. 

We propose the following order of procedure: 

I. Anamnesis (ascertaining previous history of case)- 
II. Determining the Status Pracsens. 

A. General examination. 

1. Signalment of the patient. 

2. Habitus. 

3. Skin. 

4. Conjunctiva. 

5. Temperature. 

B. Special examinations. 

6. Circulatory apparatus. 

7. Respiratory apparatus. 

8. Digestive apparatus. 

9. Urinary apparatus. 

10. Sexual apparatus. 

11. Central nervous system. 

12. Locomotion, exercise in harness or under sad- 

dle, etc. 

C. Specific examinations. 

13. Diagnostic inoculations. 

14. Examination of lymphatic glands. 

15. Examination of the blood. 

The anamnesis should be procured and the general and 
special examination should be made at least once during the 
first visit to the patient. If the diseased organ or organs have 
been ascertained they must be carefully re-examined at every 
subsequent visit, at the same time we must be on the alert for 
the appearance of possible symptoms in other organs. 

The specific examinations are made only when necessary 
for clinching the diagnosis. 

The determination of symptoms is at times difficult. 

Sometimes external influences bring about certain con- 
ditions of the healthy body which must not be interpreted as 



14 CLINICAL DIAGNOSTICS. 

symptoms of disease,, although they might, under other -cir- 
cumstances, be such ; e. g., a horse refuses its feed — this is a 
frequent occurrence in gastro-intestinal affections or in the 
course of severe general diseases, but it may also be due to an 
excitable temperament of the animal or to the fact that the food 
in itself is undesirable — spoiled, mouldy. Hence the practi- 
tioner must always endeavor to determine the cause of the 
symptoms, whether the deviations from the normal are really 
due to disease or to external conditions. 

The importance of symptoms depends very largely upon 
the conditions under which they appear. 

Rapid respiratory movements may be due to a disease of 
the respiratory apparatus or to some other affection ; again, 
they invariably occur after bodily exertions, and high tempera- 
tures, even when the animal is at perfect rest, will cause the 
respiratory movements to become accelerated. 

To avoid confusing symptoms produced by muscular ex- 
ercise, or other efforts on the part of the animal, with symp- 
toms of disease, the patient should first be examined in a state 
of rest. Furthermore, all conditions that could possibly influ- 
ence normal physiological processes must ever be taken into 
consideration ; for example, we will mention age, estral 
period, pregnancy, fright on part of the animal, etc. 

After noting the symptoms of the disease we come to the 
most difficult part of clinical diagnostics, viz : 

The determination of the organ diseased. There are 
only a few symptoms which point with certainty to an affec- 
tion of a definite organ, fewer still enable us to recognize the 
character of the disease; these latter are called pathognomonic 
symptoms. As a rule all symptoms must be first noted and 
then considered as a whole, always bearing in mind the prin- 
ciples of general and special pathology. 

We distinguish different kinds of symptoms: 

1. - Local symptoms belong to the affected organ or to 
the disease center. 



DIAGNOSIS OF DISEASES. 15 

2. Direct symptoms are due to the fundamental dis- 
ease or morbid process. 

3. Indirect or accidental symptoms are due to compli- 
cations, of the fundamental disease. 

To determine the affected organ all ascertained symptoms 
are carefully reconsidered in the order in which they were de- 
termined. The healthy apparatus are for the time being dis- 
regarded, the diseased apparatus are given special considera- 
tion. 

A variation in the normal functional activity of an organ 
does not in itself indicate disease, it may simply be a compen- 
satory variation (one due to an opposite variation in a similar 
organ) due to the primary morbid condition. The therapeut- 
ist's object is to ascertain the primarily affected 
organ, bring about a cure in this and secondarily cause the 
sympathetically affected organ to regain its natural condition 
and activity. 

To discover the primarily affected organ requires a 
knowledge of the morbid processes that take place in each 
organ and of the direct, indirect, local and general symptoms 
produced by them. This requirement is still more important 
for the final aim or ultimate purpose of diagnostics, viz : 

The recognition of the disease itself according to 
kind, etiology, intensity and duration. 
The method of examination of each organ will therefore he- 
followed by a short description of the most important diseases 
of each. 

One who has not yet learned from his school training or 
practical experience, to appreciate the various symptoms which 
characterize each of the diseases and who has not a well- 
defined mental picture of the appearance of each of the dis- 
eases with which he must come in contact, will never become 
a good diagnostician. 

Diagnosis per se has a different value depending upon 
whether it is made for a scientific or wholly practical purpose. 



16 CLINICAL DIAGNOSTICS. 

It is often symptomatic and thus merely cloaks our ignor- 
ance ; diabetes insipidus, colic, for instance. The purpose of 
diagnosis is more nearly attained when it includes the cause of 
the disease ("etiological diagnosis"), which is of value even if 
we do not know more of the cause than that it is some specific 
infection (influenza). An anatomical diagnosis is not 
conclusive because it does not indicate the cause (nasal catarrh, 
bowel catarrh). An ideal diagnosis would be "etiologico- 
anatomical" (skin glanders, acarus mange, verminous bron- 
chitis). A correct prognosis and rational treatment are largely 
dependent upon a knowledge of the cause and morbid changes 
of the disease. 

It is not enough to diagnose a nodular, itching and spread- 
ing eruption of the skin, we must also determine the cause or 
our prognosis and treatment cannot be correct and rational. 
Such eruptions are due to various causes and an exact knowl- 
edge of them is an important item. The same may be said of 
affections of internal organs. 

A final diagnosis is made either by considering the deter- 
mined symptoms directly (direct diagnosis) or by a process of 
exclusion, i. e., we review in our mind all the diseases in which 
the symptoms determined occur, or in which some of these 
symptoms occur, and then we exclude those diseases in the 
course of which, if present, we usually observe additional 
symptoms (differential diagnosis). 

Following one or the other of these methods usually 
suffices to make a diagnosis. Not infrequently, however, even 
the experienced practitioner must content himself with limit- 
ing his diagnosis to a statement of the general character of 
the disease and reserve the privilege of expressing his final 
opinion (special diagnosis) pending further observation and 
developments. This is particularly the case in the first out- 
breaks of infectious diseases when localized changes are ab- 
sent. We also distinguish between a definite, a probable, and 
a possible diagnosis. 



DIAGNOSIS OF DISEASES. 17 

The difficulties encountered in diagnosing internal dis- 
eases vary considerably ; in some cases a good anamnesis suf- 
fices as a basis for making a definite diagnosis: epilepsy, par- 
turient paresis. In other cases the experienced practitioner 
requires but a glance at the patient : tetanus. The rule, how- 
ever, is never to make a diagnosis until a thorough and careful 
examination of the patient has been made ; but here, too, care- 
fully cultivated powers of observation and extensive experience 
go a good way. To acquire either of these, of course, requires 
continued carefully and methodically conducted examinations. 
The same diseases do not always present the same set of symp- 
toms. Therefore, the more often a disease is seen by the prac- 
titioner, the more readily will he recognize it. The diagnos- 
tician should be like the experienced botanist who recognizes 
a plant in all its stages of vegetation. There will always 
remain a few cases the symptoms of which are so atypical that 
an exact diagnosis is impossible. 

If the diagnosis cannot be made definite in every respect, 
be cautious in your prognosis and therapeutics. 



I. Anamnesis. 

Full statements on the part of the owner or attendant, 
procured by cautious questioning, concerning the previous con- 
dition of the patient, the beginning and previous course of the 
•disease (anamnesis) are of great importance in diagnostics, in 
fact there are some diseases, like epilepsy, for example, that 
can as a rule be diagnosed in no other way because it is only 
in exceptional cases that we have an opportunity to observe a 
typical epileptic fit. 

As far as the veterinarian is concerned the anamnesis is 
limited to the observation of the immediate surroundings of 
the animal. In questioning attendants speak to them in a 
pleasant tone and manner and use words and expressions with 
which they are familiar ; this tends to infuse confidence and 
the result is that the information thus obtained will be more 
apt to be reliable. 

Any digression in the testimony of informants should be 
listened to with patience. One should always remember that 
every anamnesis, from whomsoever it be obtained, is more or 
less colored by the personal conceptions of the person offering 
it. This is quite apart from intentional misrepresentations, 
which are often encountered. 

A well drawn up anamnesis speaks for the technical 
ability of the veterinarian as Well as for his knowledge of the 
etiology of the diseases of our domestic animals which are 
kept under the most variable conditions. 

1. How long has the animal been sick? 
We may learn by this question whether the disease is an acute 
or a chronic one, and perhaps also the stage of development 



ANAMNESIS. 19 

which the disease has reached. Frequently the time given 
by the owner or attendant is much shorter than the actual 
duration of the disease. 

2. What symptoms has the animal shown ? 
In the beginning? Later on? The objective observation of 
the owner must be carefully sifted out from his subjective 
interpretation of them. 

3. What, in your opinion, could be the 
cause of the disease? We cannot search for the 
causes until we know the symptoms. 

W here and under what conditions did 
the animal get sick ? Feed, care, etc., play an im- 
portant role in the etiology of the internal diseases of ani- 
mals ; therefore the veterinarian must be informed not only 
as to the kind and character of the feed but also as to soil 
conditions, water, etc., otherwise he cannot intelligently trace 
the cause of the disease. 

The care and attention animals receive wield a great in- 
fluence upon the genesis of many diseases. It is rare that the 
veterinarian can obtain from the attendants reliable data con- 
cerning these. He should judge by the surroundings in this 
regard. The use to which the animal was put when the dis- 
ease occurred is of value in tracing the cause, for special uses 
predispose animals to certain diseases. 

4. A number of animals affected by the same disease 
always points to a common cause, viz.: infection or intoxica- 
tion (poisoning). The frequent recurrence of a disease in the 
same stable points to the existence of a permanent cause. 

5. It is of especial importance for the veterinarian to 
know whether any previous treatment has been resorted to 
and "what effect this may have had. Quacks often administer 
drenches containing solid particles in suspension ; these 
draughts, instead of taking their usual course, may enter the 
trachea and thus produce a fatal pneumonia. In removing 
the contents of the rectum its wall or mucous membrane is 



20 CLINICAL DIAGNOSTICS. 

also often injured. In such cases the veterinarian must ex- 
ercise care and judgment and call the owner's attention to any 
existing danger. 

Although the main points in the anamnesis should be de- 
termined before we begin our objective examination, other 
questions will present themselves in the course of the latter. 
Thus, when examining the respiratory tract we may inquire 
whether the animal coughs, and when examining the diges- 
tive apparatus inquire as to condition of bowels, frequency 
of evacuation, etc., in this way gradually completing our exam- 
ination. 

The value of a good anamnesis consists in the fact that 
not infrequently it is sufficient to base upon it a definite diag- 
nosis, i. e., careful objective observations of the layman may 
in some instances be substituted for our examination. How- 
ever, the veterinarian must always be cautious in complying 
with the oft made request of owners to treat their animals in 
absentia. Although the medicines prescribed under such con- 
ditions may do no particular harm, rational treatment thus 
delayed may prove to be a positive injury. 

Sometimes the veterinarian is misled by the anamnesis. 
This he may guard against by making a careful examination 
of the patient. When the anamnesis does not conform to the 
results of the examination, it should be accepted with caution ; 
where the opposite is true, it may be considered reliable. 



II. Determining the Status Praesens. 

To determine pathological phenomena we resort to all 
those methods which throw light upon the physical state and 
functions of the different organs. In doing this we should 
endeavor to follow a definite plan and not proceed without 
system. The following methods are generally employed and 
in the order given : 

1. Inspection. 

In examining the different parts of the hody it is always 
best that we first regard that which can be observed with the 
unaided eye. Students are apt to lay their hands upon the 
patient too soon. Superficial abnormalities are described ac- 
cording to their seat, size, color and other external manifesta- 
tions ; the size and form usually being compared with common 
objects, unless an exact description is desired when actual 
measurements are made. 

The odor emitted by the se- and excretions and the res- 
pirations is also noted. 

In designating the seat of visible pathological conditions 
the exact anatomical region occupied by them should be indi- 
cated. 



I. Head. 



Regions of the Body. 

A. Face. 

1. Xasal region with dorsum of nose, tip of nose, 

nasal openings. [Nostrils]. 

2. Labial region, with upper and lower lips, inter- 

lahial space and chin. 

3. Buccal region. 

4. Infraorbital region. 



22 



CLINICAL DIAGNOSTICS. 



5. Ocular region. 

6. Masseteric region with maxillary articulation. 

7. Intermaxillary space. 




Fig. 1. 
B. Forehead. 

8. Frontal region. 

9. Occipital region with forelock. 

10. Temporal region with the temporal fossa, infra- 
temporal groove and auricular region. [Ears]. 



II. Neck. 



11. 



12. 



13. 

14. 



Parotid region, which merges below into the laryn- 
geal region. 

Tracheal region with jugular groove, at the lower 
end of which is the supra-clavical fossa. 

Cervical region with crest and mane. 

Lateral cervical region, sides of neck. 



III. Chest. 



15. .Withers and dorsal region. 

16. Lateral pectoral region [sides of chest] with scap- 



DETERMINING THE STATUS PRAESENS. "23 

ular region, cardiac region, costal region. 

17. Sternal region. 

18. Anterior pectoral region. [Breast]. 

IV. Abdomen. 

19. Epigastric region with xiphoid space. 

20. Mesogastric region with umbilical space, iliac 

region (flank with "hollow of flank") and the 
lumbar region. 

21. Hypogastric region with pubic and inguinal region. 

V. Pelvis. 

The different divisions of the pelvis are named according to 
their anatomical parts; the sacral region is called the croup, the 
external angle of the ilium the "hip," just below the anus the 
perineal region; the anal region, pubic region and inguinal region. 

VI. Extremities. . 

The different parts of the extremities are designated according 
to the bones and joints which form their bases. Anterior limb: 
Shoulder, point of shoulder, arm, elbow, forearm, "knee," cannon, 
fetlock joint, pastern, coronet, bulbs of heels, hoof. Posterior 
limb: Thigh, stifle, leg, hock, hind cannon, etc. 

2. Palpation. 

Palpation consists in feeling the part to be examined with 
the hand or finger tips. Its object is to gain information 
through the sense of touch as to the consistency, extent, tem- 
perature and sensitiveness of a part, and permit us to recog- 
nize abnormalities which do not lie far below the surface. 
Palpation is of especial importance in taking the pulse. The 
abdominal viscera can be explored (palpated) through the 
rectum and the anatomical position, and condition of the con- 
tents determined. 

From the difference in consistency of the parts palpated, 
conclusions as to their physical nature may be drawn. The 
following peculiarities may be distinguished en palpation: 

1. A part is doughy when it feels soft and accepts finger 
imprints which it retains for a few moments, when the de- 
pressions are again filled. Tissue is of a doughy consistency 
when infiltrated with serum: (edema). 



"24 CLINICAL DIAGNOSTICS. 

2. A part is firm when it is of the consistency of normal 
liver. According to the part's resistance to the touch it may be 
firm, tendinous, solid. A cellular infiltration of tissues 
(phlegmon) or the presence of neoplasms made up of cells, 
will lend to a 'part a firm consistency (connective tissue). 

3. A part is hard when of the consistency of bone. 

4. A part is fluctuating when it is soft, elastic and undu- 
lates on pressure. Only fluids admit of such a rapid trans- 
mission of pressure (pus, blood, lymph, serum). If the 
tissue surrounding the fluid is not tense, waves are seen to 
pass over the surface of the swelling (true or soft fluctuations). 
Soft-elastic (fat) tissue or tissue impregnated with a quantity 
of fluid may also show fluctuation ; this undulating consistency 
is spoken of as pseudo-fluctuation. 

5. A part is emphysematous when it presents a puffy 
swelling which crackles and shifts on palpation ; it is due to 
the presence of air or gas in the tissue (emphysema). 

3. Percussion. 

By percussion we understand striking the surface of the 
animal body so that the parts thus set in vibration emit audi- 
ble sounds. The "percussion-sound" thus produced will differ 
with the physical condition of the vibrating parts, and these 
differences are so well marked that definite conclusions can be 
•drawn from them. 

Methods of percussion. Percussion can be practiced 
without the use of instruments [so-called immediate percus- 
sion] on small animals or large animals thin in flesh. The 
index or middle finger of the left hand is held firmly against 
the part to be percussed and struck with the middle finger of 
the right hand. The striking finger should be held somewhat 
curved and stiff. The advantage of immediate percussion lies 
in the facility with which the finger may be placed between 
the ribs and amid the long hair of some dogs and the wool 
of sheep. By this method the sense of hearing is further 



DETERMINING THE STATUS PRAESENS. 25 

greatly assisted by that of feeling. For the larger animals 
the sounds obtained from this finger-to-finger method of per- 
cussion are not definite enough for practical use. 

In the immediate method of percussion, however, the 
sound can be augmented by employing the percussion hammer 
to strike the finger which is applied to the part (finger-hammer 
percussion). 

The pleximeter and hammer (plexor) are most com- 
monly used in practice [so-called mediate percussion] as they 
permit not only of gentle percussion but the part to be ex- 
amined can be struck a heavy blow which sets deep-lying parts 
into vibration. The pleximeter should be so held that its whole 
surface is in firm contact with the part to be percussed. In 
thin animals the pleximeter should never be applied across two 
ribs, but should be made to occupy an intercostal space that 
the air between it and the body does not modify the sound. 
The force with which we use the hammer depends upon the 
thickness of the walls of the part percussed. [In fat animals 
it is necessary to use more force than in lean ones]. 

Usually two or three strokes, not too close together, 
suffice to bring out clearly the character of the sound. For 
comparison it is advisable to percuss corresponding parts on 
each side of the body. 

For a better perception of the percussion-sound it is ad- 
visable to select a suitable place. A room with closed doors 
is the best ; in rooms filled with furniture, or out of doors the 
application of percussion is never satisfactory. 

As a rule large animals are percussed while standing, 
though small ones may be placed in a recumbent position upon 
a table. Although gentle animals may stand quietly during 
the operation, very nervous horses or stubborn cows some- 
times resist. They can generally be quieted by speaking to 
them in an assuring tone and by omitting all rough usage of 
the instruments. Dogs and cats may be held by their owners 
or an attendant. 



26 CLINICAL DIAGNOSTICS. 

The Qualities of Percussion-Sounds. 

A body can only then produce a sound when it has lost 
its equilibrium and vibrates by virtue of its elasticity. Two 
principles form the basis of percussion : 

1. Solid, airless parts of the body give forth a flat sound 
of short duration and little intensity. Such a sound is called 
dull, femoral or empty. 






Fig. 2. Fig. 3. Fig. 4. 

2. If an air-containing organ is set in vibration it pro- 
duces a sound of considerable intensity, duration and tone, 
the so-called resonant sound. 

The clearness of the sound depends upon the volume of 
the air-containing organ which is vibrating. 

a. The stronger the percussion the larger is the part 
which vibrates and the fuller the sound (Fig. 2). 

b. The thinner the over-lying tissue of the thoracic wall 
the more lung tissue will vibrate and the fuller the sound 
(Fig. 3). 

c. If the volume of the air-containing organ is small in 
itself then the sound is correspondingly less intensive (Fig. 4). 

This explains the varying intensity of the sound over dif- 
ferent portions of the chest wall when the percussion blows 
are applied with equal force. The resonant sound gradually 
merges into the dull femoral as we approach the forward and 
upper portions. 



"DETERMINING THE STATUS PRAE5ENS. 27 

The resonant sound may be subdivided into : 

1. The tympanitic sound, which approaches a musical 
tone. 

2. The full sound (pulmonary resonance). 

The tympanitic and full sounds are both resonant in char- 
acter, and in both the degree of clearness can vary until they 
become identified with the dull sound. The intermediate 
stages are comparatively dulled and dull tympanitic. 

Occurrence of the Different Qualities of Percussion- 
Sounds. 

According to the above classification there are three kinds 
of percussion-sounds: The full (pulmonary resonant), the 
tympanitic, and the flat. 

1. The full sound is found over normal lung, the air in 
the alveoli, and the lung tissue, and thoracic walls vibrating. 
When the intestines are so distended with gas that when per- 
cussed their walls vibrate with their contents, a full sound is 
emitted. 

2. The tympanitic percussion-sound has a varied origin. 
It is heard: 

a. Over cavities containing air which communicate with 
the outside world, their walls beinc: either firm or yielding: 
trachea, caverns in the lung communicating with bronchi. 
The pitch of the sound depends upon the size of the cavern 
and its communicating opening. 

b. Over enclosed air-containing cavities the walls of 
which are little distended, hence over the stomach and bowels. 

c. Over lung tissue the tension of which has become 
diminished, (atelectasis, beginning hepatization). 

3. The flat (femoral, dull) sound is heard when percuss- 
ing over solid tissues which do not contain air. As the most 
forcible percussion does not produce vibrations at a point more 
than 10cm below the surface, dullness can be noted over the 



28 CLINICAL DIAGNOSTICS 

normal lung when the chest walls are covered with heavy 
muscles, fat, or edematous. swellings. 

The sound is comparatively dulled when air-containing 
parts of limited dimensions are percussed (borders of the lung, 
and under thick thoracic wall) or if small airless spaces lie 
amid those containing air (nodular thickenings in the lung). 

During the application of percussion we should note the 
resistance the part offers to the hammer or striking finger. 
[To understand what is meant by this the student should 
strike with the plexor some solid object, as a brick wall, and 
compare it with the feeling experienced when the human chest 
is percussed] . By placing the index finger on the back of the 
hammer the resistance can be better appreciated. From the 
resistance the amount of vibration that can be induced in the 
underlying parts may be determined, the greater the former 
the less developed the latter. For this reason solid, airless 
parts like muscle give a shallow percussion-sound and causes 
the hammer to suffer a jar when they are struck. 

Tactile Percussion. 

The combination of palpation and percussion is called 
tactile percussion. Through this method we endeavor to ar- 
rive at the physical condition of deep-lying parts by stroking 
the tissues covering them. 

method. The wrist and fingers should be held slightly 
flexed and fixed. The parts to be examined should be pressed 
firmly with the finger tips, exerting an interrupted stroke. 
After =uch a stroke the fingers should be allowed to dwell for 
a moment to note the recoil of the under-lying tissue the con- 
sistency of which we wish to determine. In practicing this 
form of percussion bear in mind that the deeper rather than 
the shallower tissues are to be felt. 

Tactile percussion may also be practiced with the plexor 
and pleximeter, the index finger being rested upon the back 



DETERMINING THE STATUS PRAESENS. 29 

of the hammer. It is usually better, however, to employ ham- 
mer-to-finger or finger-to-finger percussion. 

The thickness of the over-lying fat or muscular layers 
does not seriously interfere in this form of percussion. 
Through practice we learn to select the factors of importance 
to form an opinion. Deep-lying diseased conditions do not 
present through tactile percussion specific symptoms, but we 
may thus obtain valuable information in regard to the boun- 
daries and consistency of otherwise unavailable organs or 
parts. Tactile percussion simply supplements and completes 
palpation and ordinary percussion. 

Determining the Boundaries of an Organ from the 
Percussion-Sound. 

The boundary of an organ can be determined by percus- 
sion only when the organ lies superficially and emits a percus- 
sion-sound which differs from that of its neighborhood. .For 
this reason the boundary of the heart against the lung or the 
lung against the bowels may be defined by percussion. 

4. Auscultation. 

By auscultation, applying the ear to a part, we seek to 
obtain information, through the sense of hearing, as to the 
physical state or condition of deep-lying organs. For this 
reason auscultation is practiced upon the heart, lungs and 
gastro-intestinal tract. 

In human medicine auscultation is usually practiced with 
the help of instruments (mediate auscultation), the so called 
stethoscope, etc., being employed. [In veterinary medicine, 
however, the use of such instruments is very limited, the 
heavy hair coat materially interfering with and so modifying 
the sounds that false conclusions may be drawn. To a limited 
extent the phonendoscope is useful in auscultating heart 
sounds, but the hairs over the cardiac region should first be 
thoroughly moistened or oiled]. 

By simply applying the ear firmly to the part, better re- 



30 CLINICAL DIAGNOSTICS. 

suits can be obtained than by the use of instruments. In case 
the skin is dirty, blistered, or the animal is lousy, a towel can 
be placed between it and the ear. To guard against being 
bitten or kicked an attendant should hold the patient by the 
head. In large stables containing a good many animals the 
noises they produce may interfere with auscultation ; if it is 
essential to diagnosis or prognosis, the patient should be ex- 
amined in some quieter place. 



A. The General Part of the Examination. 

I. Signalment. 

By the Signalment is meant a description of the patient 
for identification by peculiar marks or characteristics. For 
forensic purposes and special cases the proper taking of the 
signalment is of great importance. It is further of some value 
in a diagnostic sense and is sometimes taken into consideration 
therapeutically. 

It includes : 

I. Kind of animal. Many diseases are peculiar to cer- 
tain genera while they do not occur in others. This is espe- 
cially true of the infectious diseases as. for instance, the horse 
suffers from strangles, and glanders ; the ox from contagious 
pleuropneumonia (lung plague), malignant head catarrh, and 
swine from hog cholera and swine plague. There are also 
special sporadic diseases which owe their origin to the pecu- 
liar anatomical or physical make-up of a genus. As exam- 
ples, may be mentioned traumatic pericarditis of the ox ; rup- 
tures of the stomach and roaring in the horse. 

II. Sex. Diseases of the sexual organs are not com- 
mon in animals, but sex is of influence in the appearance of 
some diseases. In stallions inguinal hernias which cause 
symptoms simulating colic occur; mares during the period 
of heat may act as if they were suffering from some brain 
disease (act like dummies) or may balk or show obstinacy 
when at work. In the ox urethral calculi are not uncommon. 
The condition of pregnancy is as of great importance from 
the diagnostic as from the therapeutical standpoint, because 
this condition may induce physiological symptoms that would 
be considered pathological in non-pregnant animals. In pregi 



32 CLINICAL DIAGNOSTICS. 

nant animals caution is demanded in the choice of drugs. 

III. Color and white markings. For diagnosis the 
color and markings are of less importance. White horses fre- 
quently suffer from melanotic tumors that are either super- 
ficial or located in internal organs. White areas are more pre- 
disposed to exanthemas, sunburn and "scratches." 

IV. Age. Many diseases occur either exclusively or 
generally in youth. Rachitis, diseases of the navel, strangles 
in colts, scours in calves and distemper in puppies are exam- 
ples. In old individuals diseases due to the animal's use are 
more frequent as are also chronic diseases of organs (dummies, 
heaves). 

The age is also of influence upon the prognosis in as much 
as healing, all things else being equal, is more to be hoped for 
in the young individual than in the old one. In old animals 
where the prognosis is a doubtful one all treatment is fre- 
quently omitted on economic grounds. 

V. Size. Size is of importance in posology only. 

VI. Breed. In well bred animals the reaction against 
the encroachment of disease is more energetic and the symp- 
toms are more pronounced. Certain breeds are more able to 
withstand infectious and sporadic diseases than others, this 
must be considered in making a prognosis. Breed is also 
taken into consideration in the treatment of diseases. Well 
bred, fine skinned, sensitive horses yield to the action of cer- 
tain drugs more readily than those of the opposite type. This 
is especially true where outward applications (turpentine blis- 
ters) are to be made. 

2. Habitus. 

By the term habitus we mean the general or external as- 
pect or characteristic appearance of the patient, which is de- 
termined by its physical attitude, condition, conformation and 
temperament. It offers a convenient aid in diagnosis, one 
that can be readily observed and that, in many respects, is of 



GENERAL PART OF EXAMINATION. 33 

great importance. ' Not infrequently a diagnostic conclusion 
in a clinical case is reached largely through the impression 
the patient makes upon us by its habitus. 

Obvious physiological abnormalities are sometimes of 
themselves an index to the character of the disease. How- 
ever, one should guard against reaching hasty conclusions 
from the first impressions of the patient, to the neglect of a 
thorough examination. 

I. Attitude of the patient. Healthy horses as a rule 
remain standing during the day, or if lying down they imme- 
diately rise to their feet at the approach of a stranger. They 
will frequently lie flat on the side with feet extended, pro- 
vided the halter strap is long enough and the stall of suffi- 
cient width. 

Healthy cattle (bovines) lie down often during the day, 
especially just after feeding, and they are not so prone to rise 
when approached. They seldom lie flat on the side, but in 
sternal decubitus the limbs folded under them. 

Healthy sheep jump up when approached and usually run 
away. 

The attitude of sick animals whether standing or lying 
down is often of value in diagnosis. 

Standing attitudes assumed during disease. The head 
is held stiffly and extended in pharyngitis, cerebro-spinal men- 
ingitis, muscular rheumatism, malignant head catarrh of the 
ox, and in acute encephalitis of sheep and goats. 

Very sick animals usually hold the head dozen, and as- 
sume a relaxed, languid attitude, the ears drooping; horses 
rest their feet alternately. 

Cows suffering from severe vaginitis stand with arched 
back, tail held high, and legs spread apart. They do not 
"stand over" readily in the stable, and if driven stop repeat- 
edly to urinate. 

A stiff, quiet attitude, avoiding moving as much as possi- 
ble, is characteristic of very painful affections in the chest or 



34 CLINICAL DIAGNOSTICS. 

abdominal walls (pleurodynia, pleuritis, peritonitis). Stal- 
lions suffering from incarcerated inguinal hernia and oxen 
with peritoneal hernia (gut tie) stand with the hind leg of 
the affected side held backward and outward. 

Unphysiological attitudes. Animals afflicted with brain 
troubles (acute or sub-acute encephalitis, dummies) very 
often assume unnatural attitudes. Horses stand obliquely in 
the stall, the head in a corner, resting against the wall or 
sunk under the feed box. The limbs are drawn well up under 
the abdomen, and not infrequently one leg is placed in a very 
unphysiological position, perhaps crossing its fellow of the 
opposite side. Dummies stand unusually quiet and seem 
oblivious of their surroundings. They move without energy, 
and are backed with the utmost difficulty. (See under "Cen- 
tral Nervous System," "Examination of Dummies"). 

Continued standing is observed in : 

a. Old, worn-out horses. 

b. Pneumonia and Pleuritis. As a rule if the animals 
lie down in these diseases it is on the diseased side, and for the 
following reasons : because the slight pressure of the ground 
against the body ameliorates the pain, and the pleuritic exudate 
(the effusion in the chest) does not encroach so much upon 
the heart and the still healthy lung. The respirations are 
always more difficult when the animal is lying down. [In 
peritonitis resulting from castration horses very commonly 
remain standing; when forced to move they do so with hind 
legs held in abduction, advancing very stiffly]. 

c. Severe Dyspnea. The head is held extended to allow 
the air the easiest possible access to the lungs, thus facilitat- 
ing inspiration. 

d. Horses suffering from acute diseases of the brain. 

e. Horses suffering from Tetanus. They stand with 
legs braced like a sazv horse, the head somewhat extended and 
held high, the back held rigid. It is very difficult for them 
to step sideways. The facial expression is anxious, the mem- 



GENERAL PART OF EXAMINATION. 3o 

brana nictitans appearing- plainly before the eye; the tail is 
carried high and stiff, and the gait inflexible and laborious. 

Restless Standing. Most commonly seen in horses suffer- 
ing from colic and acute brain diseases. The former are rest- 
less, lie down, roll, and get right up again. In many cases 
it is only with difficulty that they can be kept on their feet ; 
when down it may be equally hard to drive them up. They 
often look at the flanks, paw, strike the belly with the hind 
feet, switch the tail, and stretch as if to urinate without void- 
ing urine. At times they sit up like a dog. 

Like symptoms but of shorter duration are observed in 
the ox suffering from invagination of the intestines, torsion of 
the uterus in cows and from urethral stones and peritoneal 
hernia in steers. 

Horses with acute brain disease show at times rabiform 
symptoms, plunging, rearing and breaking loose. When not 
tied they keep forging ahead or continue aimlessly walking 
in a circle. 

Restless, anxious moving about is seen in many cases of 
severe dyspnea. 

gait. A labored, slow, exhausted, wobbling gait is noted 
in severe febrile diseases. It is especially marked in influ- 
enza of the horse. In tetanus, muscular rheumatism and 
purpura hemorrhagica the gait is stiff. Lameness of one or 
more limbs is seen in foot and mouth disease and pyemia 
(pyemic arthritis). The gait is unphysiological in acute and 
chronic hydrocephalus. In the trotter disease of sheep the 
patient does not walk but goes at a stiff trot. The crackling 
of joints is heard especially in equine influenza. 

Lying postures assumed during Disease. Animals 
found lying down and that can not be made to rise should be 
examined very carefully. In them the examination is always 
difficult. We should first try to drive them up by speaking 
to them in a sharp tone of voice and assisting them by me- 
chanical means. It is important to determine whether they 



36 



CLINICAL DIAGNOSTICS. 



are really unable to rise or whether they are obstinate and 
will not rise (malingerers). 

If the animals have lain for a long time on one side, it is 
advisable to turn them over before attempting to drive them up. 
The same should be done when after a fruitless effort to get an 
animal onto its feet, it falls back again to the ground and we make 
a second attempt to make it stand. 




Fig. 5 — Horse with Azoturia. 



To bring recumbent horses to their feet it is expedient, after 
placing them on the sternum, to pass the end of a long halter rope 
through a convenient ring in the wall, and keep it pulled taut; the 
hind legs should be doubled under the body in a natural position 
and the fore ones extended in front. By speaking to the animal, 
striking it over the ears and nose, and lifting by the tail, we may 
assist it to regain its feet. When this method fails, a sling should 



GENERAL PART OF EXAMINATION. 37 

"be placed under the body and the animal raised with block and 
tackle. 

The ox is often hard to induce to stand up after it has been 
down for a time. It may be able to get up, but through obstinacy 
will not do so. Whipping and beating in such cases is usually of 
no avail; yelling in the animal's ear, setting a dog on it or tieing 
its nose shut may be tried. [By placing a rope around the .body 
so that it passes beneath the brisket in front and the ischii behind, 
we have improvised a handle by which several persons can lift the 
malingerer to its feet.] 

Animals may be unable to arise : 

a. In Tetanus. Horses suffering from tetanus, if 
down, are as a rule unable to stand up without help, as the 
spasmodic contractions of the extensors of the limbs prevent 
it. When recumbent, the upper pair of legs do not come in 
contact with the ground. The animals are very restless and 
bedewed with sweat. 

b. In A z o t u r i a. Horses suffering from acute azo- 
turia make vain efforts to stand. They are sometimes only 
partially successful, the fore part of the body being raised and 
supported by the front legs, but the hind limbs are unable to 
bear their share of the weight, breaking down under it. 

c. In Spinal paralysis from Fractures of Ver- 
tebrae. The patients lose control of the hind parts which are 
no longer sensible to pain [pin pricks]. Sometimes, however, 
reflex spinal convulsions attend "broken back." Dogs with 
paralyzed hind parts usually sit sideways, the legs directed 
away from the body. 

d. Ante-and Post-part um Paresis. Occurs 
in cows before or after calving. The animals seem to be in 
comparatively good health, have a good appetite, but can not 
regain their feet. There are no further symptoms of disease 
or injury. They often lie stretched out on the side. [Prog- 
nosis is favorable]. 

e. Milk Fever (parturient paresis). The cow lies 
in a comatose condition on the left side as if in profound sleep, 
the head resting against the right chest. If the head be lifted 



38 



CLINICAL DIAGNOSTICS. 



it drops back again to its former position as soon as released. 
Sensitiveness and temperature of the whole body are dimin- 
ished. 

f. Cramp of the Neck (cerebro-spinal meningi- 
tis). After showing symptoms of stiff, wry neck, while stand- 
ing, paralysis follows. The patients lie flat on the side with 
the head drawn backward, the body convulsed with spasms. 

Old, worn out horses are hard to get upon their feet once 
they have lain or fallen down. When animals are suffering 
from severe pain in the legs and feet (founder) or when lying 




Fig. 6.— Cow with Parturient Paresis. 

on an injured limb (fracture), they can as a rule rise only 
with the greatest difficulty. Colic patients, when down, gen- 
erally do not get up promptly. 

Inspection of Herds. In examining groups or entire 
herds of animals, one should observe the behavior of each 
individual. The inspection may be conducted in the stable 
or better in the open, without undue excitement, and any ani- 
mal showing symptoms carefully noted. Sick animals are rec- 
ognized by their attitude, movements, depressed appearance, 
lack of appetite, etc. After such a preliminary survey of the 
group or herd suspected individuals may be separately scru- 
tinized. 

II. Condition. The condition of the animal is recog- 
nized principally by the rotundity and fullness of development 



GENERAL PART OF EXAMINATION. 39 

of the body. Cold blooded horses usually. have well rounded 
forms because the muscles are of large size and surrounded 
by well developed fat deposits. The condition as to flesh is 
influenced by the quantity and quality of the food and the use 
and purpose for which the animal is intended and fed. Con- 
tinued hard work reduces the fullness of the body outline, 
causing the conformation to appear angular. 

When the digestive tract is affected with disease, whether 
local or general, the condition of the animal becomes reduced. 
A gradual but continual loss of condition, notwithstanding 
that the appetite and food are good, always points to chronic 
disease, but not necessarily to disease of the digestive tract. 
When the digestive tract becomes diseased the appetite is 
impaired. 

Depending upon the use and purpose of the animal we 
distinguish the following kinds of condition: Prime, very 
good, tolerably good, fair and bad. A gradual, progressive 
general emaciation is called Cachexia. Rapid emaciation ap- 
pears in purpura hemorrhagica and in severe infectious dis- 
eases. Excessive corpulency (obesity) is common in bulls 
and dogs ; in slaughterable animals it is desired. 

III. Conformation. It is advisable to classify horses 
according to their use into heavy and light draft, carriage and 
saddle horses. The classification is based upon the animal's 
conformation. To judge of the conformation correctly we 
should take into consideration the depth of the body, breadth 
and depth of chest, curvature of the ribs, strength and angu- 
lation of the joints, and the attitude of the limbs when stand- 
ing naturally. 

Horses with flat, small chests possess poor staying quali- 
ties, the lungs correlatively being small. Horses with flat, not 
well sprung ribs, tucked up abdomens and long legs, are as 
a rule poor feeders. As such animals show continually poor 
appetites for food, the bowels are not kept well filled, hence 
the body appears deficient in depth. Hearty horses, good 



40 CLINICAL DIAGNOSTICS. 

feeders, show on the other hand, better developed abdomens, 
the bowels being distended by the large quantities of food 
they contain. The more voluminous the food, the greater the 
circumference of the belly. [The abdominal circumference is 
further increased in pregnancy and in diseases causing exu- 
dates to accumulate in the abdominal cavity, ascites]. 

Animals with curvature of the spine, abnormal bending 
of the leg bones or diffuse enlargements of joints suffer or 
have suffered from constitutional bone diseases in youth 
(rachitis). Calves with broad, beefy hind parts and wide 
loins suffer from pelvic distortion, grow slowly and should 
not be used for breeding ("Doppellender"). 

IV. Temperament. By temperament we mean the 
mental attitude the animal assumes toward impressions per- 
ceived through the medium of the organs of sense. An ani- 
mal's knowledge of what is going on about it is obtained 
through the instrumentality of the bodily senses of sight, 
hearing, smell, and touch. We distinguish between a lively 
and a phlegmatic temperament, comparing the power of quick 
perception with its opposite slow comprehension. Too much 
tendency in either direction will affect the usefulness of an 
animal. 

Animals of fiery disposition often show temper by being 
stubborn, vicious, balky, or they are very nervous, anxious, 
easily frightened, which reduces their economic value. Young 
animals, especially horses, are often restless and like to play. 

Animals of a very phlegmatic temperament may be so 
slow to move as to impair their usefulness. 

The sort of temperament possessed by an animal is shown 
by its external appearance. The countenance, expression of 
the eye, play of the ears, and quickness of movement form 
sources from which the temperament and disposition may be 
judged. The facial expression and eye give information as to 
the mental condition. 

Blind horses are often scary ; they employ the sense of 



GENERAL PART OF EXAMINATION. 41 

hearing, moving the ears in a lively manner to take the place 
of the lost sense of sight, at the same time holding the head 
still. This may cause us at first sight to suspect that the 
animal is suffering from a brain disease. Old horses are not 
so sensitive to outside impressions as colts. Some colts, how- 
ever, are little observing of their surroundings, appearing dull, 
stupid and lazy, without suffering from disease. Great fatigue 
produces temporary physical and mental depression also tem- 
porary loss of appetite in phlegmatic individuals. 

Febrile diseases affect the temperament, making the 
animal affected sluggish in its movements. In animals of fiery 
temperament this is not so noticeable. 

In animals suffering from severe, serious diseases, the 
temperament can become so changed that vices, such as crib- 
bing, biting, kicking, etc., are no longer indulged in. The 
countenance appears blank, expressionless, staring, eyes 
sunken, locomotion slow and unsteady. A few hours before 
the fatal termination of a disease, the normal tonus of the 
tissues is lost, the muscles relax, especially those of the face, 
forming the so-called Hippocratic countenance (fades Hip- 
pocratica), one of the symptoms of approaching death. 

Diseases Which Are Characterized Particularly by Change 

in Habitus. 

Colic is a complex of symptoms in the horse characterized 
by abdominal pain and suppressed peristalsis. It is due to some 
affection of the stomach or bowels. For the symptoms in regard 
to manner in which pain is shown, see page 35. Further symp- 
toms are sweating, congested, "muddy" conjunctiva, accelerated 
pulse, dyspnea, anorexia, suppressed peristalsis, obstipation. The 
cause which lies at the bottom of these clinical phenomena can 
be determined only by careful examination of the abdomen. (See 

this.) 

Azoturia is an acute auto-intoxication in the horse character- 
ized principally by a peculiar severe parenchymatous inflammation 
and paralysis of the muscles and complicated by hemoglobinemia 
and'acute nephritis. It appears suddenly under symptoms of par- 



42 



CLINICAL DIAGNOSTICS. 



alysis of one or both hind limbs, inability to stand, restlessness 
and sweating. Croup muscles tense, hemoglobinemia, hematuria. 
No fever, mind clear, dyspnea, appetite retained. When standing 
knuckle in joints of affected limb; make ineffectual efforts to re- 
gain feet; hind limbs unable to support body. 

Polyarthritis (articular rheumatism). Febrile infectious dis- 
ease with inflammation of usually several joints. Without appa- 
rent external cause there appear suddenly hot and painful swell- 
ings of joints. Patients remain lying; high temperature, no appe- 
tite, cease ruminating. Most common in ox; rare in horse. 

Muscular rheumatism (myositis rheumatica). Peculiar in- 
flammation of individual muscles or groups of muscles. Charac- 
terized by wandering, periodical pains. Mostly confined to limbs 




Fig. 7.— Rachitic Dog. 



and back; head rarely affected. Temperature not high. Not in- 
frequently complicates other diseases, especially those due to 
refrigeration. Most common in horse, dog and swine. 

Cerebro-spinal meningitis (cramp of the neck). Probably in- 
fectious. Symptoms vary. Delirium, spasms of the muscles of 
the head, neck and limbs. High fever; dysphagia. Patients re- 
main lying with head drawn back (opisthotonus). 

Parturient paresis (milk fever). See pages 37, 38. 

Rachitis and osteomalacia. Both of these diseases are char- 
acterized by the bones being deficient in lime salts. Such bones 



GENERAL PART OF EXAMINATION. 43 

possess little power of sustaining weight, hence they suffer change 
in form when weight of the body must be borne by them. 

a. Rachitis appears only in young animals, mostly in pigs 
and puppies. Pathologically the disease may be considered tlo be 
a remaining softness of the bones, the epiphyses becoming en- 
larged, the diaphyses bent. An upward curvature of the spine ^^ 

is called kyphosis, a downward ^^ lordosis, a lateral j scoliosis. 
Animals suffering from rachitis remain lying a great deal, find 
trouble in regaining their feet, and locomotion is difficult. 

b. Osteomalacia. Fragility of the bones is seen only in adult 
animals (cattle). The animals lie down continually, are weak, eat 
but little, and become thin in flesh. The bones of the extremities 
become brittle; spontaneous fractures, decubitus, and death ensue. 

3. The Skin. 

The condition of the skin indicates the state of health. 
The condition of the skin is affected not only in local diseases 
of that organ, but in many maladies of a general nature, 
involving internal viscera. An examination of the integument, 
therefore, is of importance to diagnosis. The skin is examined 
by inspection and palpation ; in local diseases the microscope 
is employed. An examination of the skin includes the fol- 
lowing : 

I. Condition of the hair coat. In horses and cattle in 
good condition the hair is usually short, fine, glossy, and lies 
smoothly. Horses running on pasture or kept in unsanitary 
stables, show a long, lustcrlcss, rough, bristling, hair coat. 
If the condition of the hair coat is bad, notwithstanding good 
care and shelter, it may be assumed that the animal is suf- 
fering from ill health. The appearance of the hair coat is 
influenced mostly by chronic diseases. Temporarily the hairs 
may become erect when the animal is carrying increased tem- 
perature (chill) or from the effects of cold air or water. 

In long haired animals the hair coat should lie closely 
matted and the hairs have the same general direction. 

S h e d d i n g o f t h e hair. In horses and cattle a par- 
tial shedding of the hair occurs normally each fall and spring. 



44 CLINICAL DIAGNOSTICS. 

In the fall the long, soft winter coat appears ; this is shed the 
following spring. [Animals kept blanketed in warm stables 
retain a short hair coat throughout the winter.] Good care 
and proper food hasten the shedding of the hair, contrary con- 
ditions tend to postpone it. When the winter coat is retained 
during the summer months, it indicates usually chronic disease 
of nutrition. 

When horses which have been poorly kept pass into good 
hands and receive nourishing food and good attention, an 
unusually early shedding of the winter coat follows. 

Alopecia. A loss of hair over the whole or a large 
part of the body (alopecia) sometimes quickly follows the re- 
covery of an animal from a severe infectious disease {con- 
tagious pleuropneumonia of the horse). A gradual loss of 
coat accompanies chronic, cachectic diseases in sheep and 
dogs. In chronic diseases affecting nutrition the hairs be- 
come loose, and may be easily removed by pulling or rubbing. 
Horses clipped late in the season (November, December) grow 
short winter coats ; when these are shed the following spring, 
the skin is left partially denuded of hair, giving the animal 
a half-naked appearance. 

Where the hairs fall out in patches, and lesions are found 
in the skin, a disease of the integument is present. 

II. Sweat secretion. The skin is kept continually 
moist by the secretions of the sweat glands. In healthy ani- 
mals at rest the supply of secretion is just sufficient to keep 
pace with the loss by evaporation, so that the skin does not 
feel wet but soft and pliable. The skin's moisture is increased 
by exercise, high atmospheric temperatures and nervous ex- 
citement. Sweating does not become visible in swine, sheep, 
dogs, and cats. 

In disease a more or less profuse outbreak of 
sweat (hyperidrosis) appears: — 

1. When an animal is much weakened from acute or 
chronic disease. 



GENERAL PART OF EXAMINATION. 45 

2. In severe dyspnea, where it is compensatory, assist- 
ing the lungs to throw off effete matter; stenosis of the 
anterior respiratory passages, diffuse pneumonias, pulmonary 
emphysemas, and organic heart diseases. 

3. In painful maladies: founder, colic, enteritis. 

4. In diseases painfully affecting the muscles: tetanus, 
epilepsy, azoturia, cerebro-spinal meningitis. 

Normally, perspiration is accompanied by a hyperemia of 
the whole skin. If this congestion is absent, the sweat being 
excreted upon a cold skin surface, "cold sweat" is spoken of. 
a condition to be judged unfavorably from a prognostic stand- 
point. 

Local sweating (liyperidrosis localis) , or sweat 
appearing on only one side of the body (hcmidrosis) is seen 
at times to accompany diseases of the nervous system. 

A decrease in sweat secretion (hyphidrosis) 
can be so well developed that the skin feels dry (auidrosis). 
This condition can best be appreciated on the muzzle of the 
ox, the snout of the hog, or the nose-tip of the dog. These 
parts in healthy animals are moist and nearly cold. During 
high fever, severe diarrhea, diabetes insipidus (polyuria), 
hyphidrosis is a common attending symptom. In severe dis- 
eases where life is threatened, the nose feels cold and dry. 

III. Color of the skin. The hair and pigment prevent 
us from seeing that color of the skin which is caused by the 
blood and other physiological fluids flowing through it. With 
the exception of the horse, nearly all white-coated animals 
have non-pigmented skins. [Horses having white or grey 
hair coats show pigmented skins, the white-born (albino) 
horses forming an exception. The parts of the skin which 
show white markings (legs, forehead) are as a rule not 
colored] . 

Chronic discharges from natural openings (the eye, nose, 
vulva) cause a loss of pigment from the portions of 
the skin over which thev flow. 



46 CLINICAL DIAGNOSTICS. 

An injection (reddening) of the skin is only of 
diagnostic importance when not produced by local diseases of 
the integument. A diffuse reddening of the skin, namely of 
the abdomen, neck and between the. thighs, is seen in swine 
erysipelas (Rothlauf). Red spots, often angular in shape, 
accompanied by swelling of the skin, appearing usually over 
the neck and along the back, are seen in urticaria and in mild 
cases of erysipelas in swine. 

The skin becomes bluish red (cyanotic) when the 
blood is heavily charged with carbonic acid gas. It is seen 
in diseases causing swelling of the glottis, heart diseases, con- 
gestion and edema of the lungs, and in overdriven sheep or 
swine during hot weather. 

Yellow (icteric) discoloration and paleness of the 
skin will be considered under "Examination of the Conjunc- 
tiva." (See page 60.) 

IV. Condition of the skin. The skin of a healthy ani- 
mal feels pliable and elastic, and is movable upon its underly- 
ing tissues. If a fold of it be drawn out between the fingers, 
it soon regains its former place when released. 

Where the animal is poorly nourished, out of condition, 
or emaciated from wasting disease, the skin feels hard and 
leather-like (sclerosis, induration). [If the subcutis has also 
lost its elasticity, and the skin adheres closely to the under- 
lying parts, and cannot readily be drawn out in folds, it 
causes a condition that is commonly termed "hide boundness"]. 

In the hide bound animal the epidermis is dry and 
tough, the outer epidermal layer becomes loose and may be 
easily removed. 

The skin is thus coated with a thick layer of scales and 
the hair filled with dandruff. 

The exhalations of the skin sometimes have a 
penetrating urinous odor, noted not infrequently from bladder 
rupture, the contents of the organ being poured into the ab- 



GENERAL PART OF EXAMINATION. 47 

dominal cavity. In the ox urethral calculi commonly cause 
this condition. 

V. Swellings in, and immediately under, the skin. 
Diffuse or multiple swellings appearing in or immediately 
under the skin are of great importance as an aid to the diag- 
nosis of internal diseases which they accompany. 

Tumefactions of the skin attend the following morbid 
processes : 

Edema of the skin and subcutis (anasarca) 
is an abnormal accumulation of serum in the connective tissue. 
It is produced by a transudation of fluid (liquor sanguinis) 
from the blood into the intercellular spaces. The lymph 
spaces being clogged prevents the escape of the fluid. Ede- 
matous swelling are doughy on palpation and retain finger im- 
prints. 

Edema can be due to : 

a. Continued venous congestion, the free circulation of 
the blood being interrupted (dropsy from stasis). In such 
cases a dropsical swelling appears in pendent portions of the 
bodv, removed from the heart. The prepuce, in front of the 
mammae, ventrally along the abdomen and thorax, hind limbs, 
brisket and throat are the favorite seats of these enlarge- 
ments which are neither painful nor hot. Any morbid condi- 
tion which interferes with the free flow of the blood through 
the veins, leading to a stagnation in these vessels, tends always 
to produce edematous swellings. They attend organic heart 
troubles, chronic pleuritis, pericarditis, and traumatic peri- 
carditis of the ox. 

b. A watery condition of the blood (hydremia) with 
which occurs an abnormal porosity of the blood vessels, and a 
subsequent transudation into the tissues. The edema of 
hydremia shows neither increased warmth nor pain. Drop- 
sies due to hydremia are noted under the jaws of sheep 
afflicted with animal parasites, [the lung and stomach worms. 
Sir. contortus, Str. filaria ; liver flukes. Dist. hepaticum, being 



48 CLINICAL DIAGNOSTICS. 

the most common]. Leucemia and anemia are frequently 
attended with skin dropsies. 

c. Inflammatory edema (collateral edema) also pro- 
duces swellings of the skin, but this is usually local. It is 
characterized by pain and increased warmth. In one form 
of anthrax appears a circumscribed, hot, hard, painful tumor 
on the neck, head, or body — the malignant carbuncle. 

In some of the infectious diseases a more or" less diffuse, 
or a multiple inflammatory edema, becomes manifest ; in in- 
fluenza of the horse the eyelids, scrotum and limbs swell ; in 
purpura hemorrhagica multiple, later diffuse tumefactions 
occur on the head, prepuce, lower abdomen, and limbs. [Leg 
swellings in purpura are characterized by their abrupt, bolster- 
like, termination]. A local, hot, edematous swelling often 
betrays the presence of deep-lying inflammation — pus, and is 
therefore important in diagnosis. In strangles of horses 
suppuration in unavailable lymph glands is determined by the 
accompanying edema of the skin in the region of the throat ; 
in glanders it occurs about the farcy bud ; in traumatic 
peritonitis of cattle a hot, doughy swelling appears in 
the hypochondrium. 

Emphysema of the skin. Emphysema of the 
skin signifies the presence of air in the subcutaneous tissue. 
Such swellings crackle on palpation and are usually well de- 
fined. The contained air can be temporarily displaced by 
applying pressure to parts of the swelling, but as soon as the 
pressure is released the space caused by it refills. 

Emphysema originating spontaneously is infrequent. It 
is mostly due to the formation of gas in decomposing blood 
extravasates or retained abscesses (emph. septicum). Spon- 
taneous emphysema is pathognomonic of symptomatic anthrax, 
black leg, where it appears upon the back, neck, and muscular 
portions of the legs. 

Emphysema occurs most frequently from the aspiration 
of air from without into the subcutis. The air may enter 



GENERAL PART OF EXAMINATION. 49 

through a wound in the skin, or may come from some air- 
containing internal organ. 

In the first case ' the air is sucked or pumped into the 
subcutis through skin wounds which continually shift posi- 
tion during locomotion. Wounds in the neighborhood of the 
elbow, therefore, produce emphysema of the shoulder and 
neck. It is a common practice to treat atrophies of super- 
ficial muscles ("sweeny") by inflating the overlying skin with 
air artificially introduced by a bicycle pump or pipe stem]. 
In the second case the emphysema of the skin has its origin 
from an internal organ, usually the lung, the alveoli of which 
are ruptured (interstitial pulmonary emphysema). The 
course followed by the air is as follows : It passes from the 
ruptured alveoli into the subpleural connective tissue, making 
its way to the mediastinum, between which folds it continues 
to the upper part of the thorax, then following the course 
of the trachea, large blood vessels and esophagus, it escapes 
from the pectoral cavity through its anterior aperture into 
the subcutaneous and intermuscular tissues. Rupture of the 
pulmonary alveoli may result from a destruction of the lung 
tissue by pus or putrefaction (gangrene). Rib fractures in- 
volving the lung, great intra-thoracic pressure from violent 
coughing, continued bellowing, forced contraction (straining) 
of the abdominal muscles in bowel, bladder and uterine trou- 
bles, may be at the bottom of emphysema of the integument. 

Sometimes after rumenotomy or trocaring, gas passes 
from the paunch through the muscular wound into the sub- 
cutaneous tissue. The skin wound having shifted position, 
the escape of the gas to the surface is prevented, hence it 
collects in the loose connective tissue along the back. 

Diseases of the Skin. 

The following terms are most commonly employed to denomi- 
nate the phenomena of skin lesions: 

1. Spots (maculae) are well circumscribed abnormal colora- 
tions of the skin. 



50 CLINICAL DIAGNOSTICS. 

2. Papules {papulae) are small cutaneous elevations of solid 
consistency varying in size from that of a pin head to that of a 
small pea. 

3. Vesicles (vesiculae) are elevations of the outer epidermal 
layer due to the accumulation of fluid beneath. They vary from 
the size of a millet-seed to that of a pea. 

4. Blisters (bullae) are large vesicles. 

5. Pustules (pustulae) are vesicles containing pus, and are 
therefore colored yellow. 

6. Ulcers (ulccra) are suppurating wound surfaces which re- 
sult from necrosis of tissue. 

7. Scales (squamae) are epidermic lamellae which have be- 
come detached from the skin's surface. 

8. Scabs, or crusts, are dried masses of exudate upon the sur- 
face of the integument. 

9. Hives (urticaria, nettle rash) are due to swellings of the 
papillary bodies, producing well-defined evanescent rounded ele- 
vations, resembling welts raised by a whip. 

I. Non-parasitic Skin Diseases. 

1. Alopecia (baldness) is a loss of hair due to some disturb- 
ance in the skin's nutrition. It may not be attended by lesion. 

2'. Blood sweating (hematidrosis) is the spontaneous appear- 
ance of blood upon the apparently intact surface of the integument. 
It is peculiar to Hungarian horses. 

3. Prurigo is a papular eruption accompanied by intense itch- 
ing. Biting and rubbing induce additional lesions. 

4. Summer surfeit (acne simplex) is a nodular eruption occur- 
ring usually over the neck and shoulders, leading to a loss of hair. 
[It is seen mostly during the hot months. This condition is often 
erroneously attributed to some "disorder of the blood." Its chief 
cause is neglect of proper grooming and care of the skin of horses.] 

5. Fagopyrism is an acute, diffuse, itchy inflammation of the 
non-pigmented skin of the head, due to grazing on growing buck- 
wheat in bright sunshine. Brain symptoms sometimes compli- 
cate the disease. 

6. Eczema. In a general way the term eczema designates an 
exudative dermatitis. It has much in common with the catarrhs 
of mucous membranes, and like the latter can pass through the 
varied stages of erythema with desquamation, papule, vesicle and 
pustule formation and finally squammae. It is very common in 
dogs, appearing along the back. 



GENERAL PART OF EXAMINATION. 51 

7. Foot eczema, produced by potato residue, swill and brewer 
grain feeding, is a vesicular eczema occurring on the hind legs of 
the ox. The vesicles rupture soon after formation and their con- 
tents dry to thick yellow scabs. The hair of the affected parts 
stands erect and part of it falls out. In most instances the eczema 
reaches no higher up the legs than the hock, but may spread to 
the body or involve the anterior limbs. 

II. Skin Diseases Due to Animal Parasites. 
The common skin parasites are: 

1. Lice or Pediculidae (Haematopinus asini, eurysternus, 
urius, etc.) 

2. Bird lice or Mallophaga (Trichodectes equi, scalaria, etc.)* 

3. Louse flies or Hippoboscidae (Hippobosca equina, Meloph- 
c'gus ovis). 

4. Ticks or Ixodidae (Boophilus bovis) Texas cattle tick. 

5. Fleas or Siphonaptera ( Ceratopsyllus serraticeps of dog, 
Pulex irritans of man). 

6. Bird ticks or Gamasidae (Dermanyssus avium, D. gallinae). 

7. Mites or Acarina ( Chorioptes, symbiotes, horse, ox, goat, 
etc.). (Psoroptes communis, horse, ox, sheep, etc.). (Sarcoptes 
equi, canis, suis, cati. etc.). (Sarcoptes mutans of fowl). (Acarus 
folliculorum or Demodex folliculorum, var. canis, suis, etc.). 

o a f*^ common hen louse Menopon pallidum, is remotely related to the trichodectes 
hfl T» f th t m L n gene , ral appearance. It is said to pass readily to other species of 
birds, and to trouble horses kept near lousy henroosts.] »="»«* 



52 



CLINICAL DIAGNOSTICS. 



Fig. 8- 




Hacmatopinus equi. 
Blood-sucking Louse. 



Fig. 9. 




Trichodcctcs equi. 
Scale-eating Louse- 



Fig. 10 



Fig. 11. 




Symbiotcs bovis. 
Ventral side. 



Psoroptes communis. 
Ventral surface, Egg in Oviduct- 



GENERAL PART OF EXAMINATION. 



53 



Mange (scabies) is a contagious dermatitis due to mites. The 
principal manges are: 

a. Symbiotic mange (foot mange). Favorite seats: in the 
horse, hind limbs, in the ox, root of tail. These mites live on the 
skin, produce loss of hair, desquamation of epithelium, and intense 
pruritis, causing the animal to stamp and kick continually. The 
mites are 0.3 — 0.5 mm long, head broad. The legs, which are long, 
are provided at their ends with bell-shaped suckers. 

b. Sarcoptic mange of fowls ( Dermatoryctes mutans). It 
affects the legs, causing "Scaly Feet." The lower, naked portions 
of the legs become coated with calcarious, smeary or honey-like, 
scaly, thick deposits. The mites are 0.2 — 0.5 mm long, legs 
short, second pair well removed from first. U-shaped chitinous 
shield behind head. 

c. Psoroptic mange. Seen in the horse, sheep and ox. Char- 
acterized by great desquamation, the appearance of vesicles and 
papules, the hair or wool agglutinated by crusts of dried exudate; 
wool becomes tufted, falls out in patches, intense pruritis. The 
psoroptes is the largest mange mite, 0.4 — 0.7 mm long; head long, 
pointed, the three-jointed legs provided with tulip-shaped suckers. 

Fig. 12. 




Fig. 13. 



Sarcoptcs scabici. 
Ventral side. 



A cants 
folliculonim. 



54 



CLINICAL DIAGNOSTICS. 



d. Sarcoptic mange. Seen in the horse, dog, swine and cat, 
etc. This mite burrows tunnels in the epidermis, causes nodules, 
crust formation, thickening and folding of the skin, pruritis. Most 
difficult mite to capture for microscopical examination; to obtain 
material for examination the skin should be scraped to bleeding. 
Sarcoptes are very small, turtle-shaped mites measuring 0.2 — 0.5 mm 
head horse-shoe shaped, legs short and stumpy. 

e. Acarus mange. Most common in dogs and swine, ap- 
pearing principally on the eyelids, head, extremities, causing 
little itching. Skin covered with scales, small pustules, and is 
thickened and folded. In the squamous form circumscribed, bald : 
bluish-red areas occur, epidermis mother-of-pearl-like, scaly. The 
parasite is vermiform, 0.2 — 0.3 mm with a long, narrow, jointed 
body, the anterior portion carrying four pairs of short, three- 
jointed feet, at the end of each, three pointed hooks. Eggs spindle- 
shaped. 

III. Skin Diseases Due to Plant Parasites. 

Ringworm (Herpes tonsurans) is induced by the fungus Tri- 
chopyton tonsurans. The disease is characterized by the appear- 
ance of small round, well-defined hairless patches. The smooth 
skin, is covered with grey-colored, asbes- 
tos-like crusts. Spontaneous healing begins 
in the center of the lesion, extending 
toward the periphery ("ringworm"). Vesi- 
cles rarely appear. Most common in the 
ox. In the crusts and more especially in 
the hair follicles great numbers of round 
or ovoid, light-refracting spores can be 
seen with the aid of the microscope. The 
spores measure 4u. Some of the spores are 
arranged in regular order, like a string of 
beads, others are disposed in irregular 
groups. The filaments, which may be sim- 
ple or jointed, show little tendency to 
branching; their free ends are rounded. 

Favus. Rare, but appears in fowls as 
so-called "white comb" (Tinea galli). 
Small whitish-grey spots come upon the 
comb, which gradually is encrusted by 
them. In mammals thick, depressed, yel- 
lowish brown crusts appear. 



Fig. 14. 




Trichophyton tonsurans. 



GENERAL PART OF EXAMINATION. 



55 



IV. Acute E x a n t h e m a s . 

1. Foot and mouth disease [said not to occur in the United 
States], is an acute infectious disease of cloven-hoofed animals, 
characterized by the appearance of vesicles upon the mucous 
membrane of the mouth, the skin of the coronet, and in the inter- 
digital space. Period of incubation 1 to 3 days. The disease is 
attended by moderate fever, salivation, diminished appetite, lame- 
ness, recumbent position. The vesicles rupture, leaving erosions 




Fig. 15. — Urticaria. 



on the mucous membranes, and dry scabs on the skin. Complica- 
tions are not infrequent. 

2. Sheep pox is a contagious exanthema running an acute 
course and having a typical character. Incubation 4 to 7 days; 
artificial inoculation shorter. On the haired portions of the body, 
around the eyes, nose, mouth, inner surfaces of the legs, appear 
punctiform reddenings (pimples), later papules. In about six days 



56 CLINICAL DIAGNOSTICS. 

the papules are covered by vesicles filled with a clear, tenacious 
fluid (eruptive stage). In the next few days the contents of the 
vesicles become turbid, forming pustules (suppurative stage); then 
drying of the pustules to a solid crust (exsiccative stage). When 
the crusts fall off a small depressed cicatrix (pit) remains. During 
the eruption there is fever, loss of appetite, etc. Course about 3 
weeks. [Mortality 10 to 50%]. 

3. Canadian horse pox. A contagious pustulous exanthema 
limited usually to the saddle and harness rests. Period of incuba- 
tion 2 to 3 days. A few isolated prominences of the size of a half 
dollar appear, the hair on them is erect and gathered into tufts. 
The contents of the bullae becomes purulent, erupts, dries to a 
brownish-yellow solid crust. Caused by a bacillus measuring 2u, 
which admits of staining with fuchsin. 

4. Urticaria (nettle rash) is a peracute exanthema which is 
characterized by its sudden appearance. Tumefactions from the 
size of a pepper-corn to that of a hand or saucer come upon the 
neck, head, inner surface of the hind limbs and on the body. They 
are prominent, flat, soft, warm, the hair upon them standing erect; 
itching is rare. Urticaria of swine is to be looked upon as a mild 
form of erysipelas. 

V. GeneralDiseases which Affect the Skin. 

1. Purpura hemorrhagica (morbus maculosus) is an acute in- 
fectious disease (an intoxication) characterized by the appearance 
in the various organs of the body, of multiple hemorrhagic centers 
of varied size. In the absence of complications, the disease is 
unattended by fever. On the jnucous membranes of the nasal pass- 
ages blood spots are seen, more rarely they occur in the conjunc- 
tiva and buccal mucous membranes. In the skin and subcutis of 
the lips, cheeks, and nostrils, appear hard, inflammatory, edema- 
tous swellings from the size of a pigeon's egg to that of a hand 
(larger by confluence), causing the head of the horse afflicted to 
resemble that of a hippopotamus. The extremities also swell, the 
swellings terminating abruptly at the stifle and the elbow. There 
is a diffuse edema of the lower abdomen; hemorrhage in the 
internal organs. Breathing is labored and stentorious from the 
mechanical obstruction (swelling) to the entrance of air into the 
upper respiratory passages. There is difficulty in deglutition, colic 
symptoms, and impaired locomotion. When the disease has existed 
for several days, the temperature increases. [Course atypical, 6 to 
21 days. Mortality about 50%]. 



GENERAL PART OF EXAMINATION. 57 

"VI. Acute Infectious Diseases which Affect 
t h e Skin. 

1. Black leg (symptomatic anthrax) is an acute infectious dis- 
ease caused by the entrance of a germ through [the digestive tract 
or] a lesion in the skin, a peculiar emphysema resulting. On the 
body, shoulder, neck, upper portions of the extremities (never be- 
low the knee or hock) appear swellings which are at first hot 
and painful, but later cold, painless, emphysematous. Incision 
causes a foamy, fetid fluid to flow out of them. Attending symp- 
toms are high fever, great depression, lameness, dyspnea. Mor- 
tality is high. [Prophylaxis, protective inoculation]. 

The bacilli of black leg are contained in the discharges from 
the swellings. They measure 3 — 5u long, 0.5 — 0.6u broad. One end 
or the middle is enlarged to receive an ovoid spore which it bears. 
May be stained by Gram's method. 

2. Malignant edema appears under the same symptoms as 
black leg; the swellings are more edematous than emphysematous. 

The bacillus of malignant edema is somewhat like the bacillus 
of anthrax, 3. — 3.5u long and l.lu broad. They are mostly 
united at their ends to form long threads. In the middle of some 
of the bacilli or at the ends occur spindle or drumstick-like en- 
largements to receive the ovoid spore. The spore does not accept 
ordinary stains. 

3. Bovine pest (Rind und Wildseuche) is produced by the 
bacterium of hemorrhagic septicemia and appears in the exan- 
thematous, pectoral, or intestinal forms. On the head and neck 
appear large inflammatory edematous swellings, which spread to 
the mucous membranes of the mouth and throat. The pectoral 
form is attended by a croupous-hemorrhagic pneumonia with pleu- 
ritis, and the intestinal form with hemorrhagic enteritis and swell- 
ing of the intestinal viscera. The Bacterium septicemias liacmor- 
rhagicae, like that of contagious pneumonia of swine and of 
chicken cholera, is 0.6u long, 0.3u broad, oval, stains only at the 
ends, an unstained belt remaining. 

4. Examination of the Conjunctiva. 

The examination of the conjunctiva serves to determine 
the quantity and condition of the circulating: blood. 

Method. Avoid all rough and hasty manipulations. Before 
grasping the eyelid gain the animal's confidence by arranging the 
foretop and gently stroking the forehead. The right evelid should 



58 



CLINICAL DIAGNOSTICS. 



be lifted with the fingers of the left hand, the left one with those 
of the right hand. By means of the thumb the upper eyelid is 
raised, the index finger then replaces the thumb, and by gently 
pressing the everted lid inwardly, the mucous membrane of the 
upper eyelid and the membrana nictitans become visible. The 
thumb, which is now free, draws the lower lid downward. The 
other three fingers may be rested against the zygomatic arch,, 
steadying the hand. (See figure 16). 




Fig. 16. 

In the ox a good view of the scleral conjunctiva may be ob- 
tained by simply taking hold of a horn and the nose, and drawing 
the head to one side. 

If we wish to arrive at the condition of the blood from 
an examination of the mucous membrane of the eye, that 
organ must be free from local irritation. Severe exercise,, 
and high atmospheric temperature cause a healthy mucous 
membrane to appear very red from physiological congestion ; 
local inflammation also produces congestions. 

A careful comparison of both eyes will enable us to deter- 
mine the presence of local inflammation. In healthy animals- 



GENERAL PART OF EXAMINATION. 59 

the color of the conjunctiva is pale-roseate; in the ox paler 
than in other animals. A few blood vessels are always visi- 
ble. In the conjunctiva, the boundary between normal and 
diseased conditions is not sharply drawn, hence practice alone 
makes one capable of giving a reliable judgment. 

I. Discharge from eyelids. Although mostly due to 
local diseases, some of the infectious diseases have discharges 
from the eyelids constantly present. The discharge is either 
bilateral (from both sides) or unilateral (from one side only). 
Bilateral discharges are seen in: malignant head catarrh (with 
keratitis), bovine pest (no keratitis present), dog distemper, 
fowl cholera, influenza. (Swelling shuts off the tear ducts). 
Unilateral discharges occur: in continued chronic nasal 
catarrh, a symptom of glanders, chronic nasal or sinus catarrh. 
[In all animals showing unilateral discharge from the eyelids, 
especially when the discharge is copious, a careful examination 
for foreign bodies should be made]. 

II. Color. The color of the conjunctiva is due to the 
quantity of blood circulating in the blood vessels of the organ 
and the amount of hemoglobin contained in the blood cor- 
puscles. A pale, anemic color shows that the animal is either 
deficient in blood or that the blood does not contain its nor- 
mal quota of red corpuscles. The color varies from reddish- 
white to greyish-white or white. 

Paleness occurs suddenly : 

1. Following great loss of blood, internal hemorrhages 
(liver, heart, large blood vessels, etc.). 

'?. In congestion of blood in the intestines (embolism of 
intestinal arteries, displacement or torsions of the bowels). 

Paleness appears as a chronic condition : 

3. In constitutional diseases of the blood-making organs 
(leucemia, hydremia). 

4. In all chronic diseases which lead to anemia or 
hydremia, glanders, tuberculosis, distomatosis (liver dukes) 
and parasitic diseases of the stomach and lungs of sheep. 



'60 CLINICAL DIAGNOSTICS. 

Venous engorgement does not come from plethora. It 
may be ramiform, diffuse or punctifortn, and varies in color 
from a brick red to dark red or muddy (cyanotic). 

Ramiform congestion from disease occurs : 

1. In congestion of the head due to hyperemia of the 
brain, encephalitis. The blood vessels are plainly marked in 
the diffusely reddened conjunctiva. 

2. When the return of the venous blood from the head 
is retarded. Characterized by distension of the veins. Occurs 
in organic heart diseases, heart's weakness, pulmonary em- 
physema. 

A diffuse, faded bluish-red discoloration of the conjunc- 
tiva is found in conditions leading to an overcharging of the 
blood with C0 2 . It is seen in febrile diseases (infectious 
diseases), and wherever air is prevented from passing freely 
into the lungs : diseases of the respiratory tract, respiratory 
muscles, or heart. 

Inflammation of the mucous membrane of the gastro- 
intestinal tract in the course of colic, produces a cyanotic con- 
junctiva; if fever appears it becomes ramiform (a bad sign). 

Yellow (icteric) discoloration (jaundice) 
is best observed on the scleral conjunctiva. It is not noticeable 
by artificial light. If the conjunctiva is pale (bloodless), the 
yellow can be more readily appreciated. The shades vary 
from a mere trace of yellow to pronounced lemon yellow ; in 
most cases combined with congestion. The icteric discolora- 
tion is due to the abnormal amount of bile coloring matter 
found free in the blood serum. 

According to the origin of the yellow coloring matter we 
distinguish : 

1. Hematogenous icterus originates from a dissolution 
of the red blood corpuscles, the coloring matter becoming set 
free and mixing with the blood serum. Hematogenous icterus 
is really a hemoglobinemia. The dissolved blood coloring 
matter (the methemoglobin) is not changed to bile pigment 



GENERAL PART OF EXAMINATION'. 61 

in the blood, but in the liver. If this organ is able to convert 
all of the coloring matter to bile and excrete it .through the 
bile ducts, the urine will contain no bile, but the feces will 
become stained by it (hypercholia) and assume a dark color. 
It may happen, however, that the bile becomes so thick that 
it congests the smaller bile ducts, is reabsorbed and stains the 
urine. 

Hematogenous icterus is seen in influenza of the horse, 
azoturia, pyemia, septicemia [Texas fever], and in certain 
cases of poisoning, especially after prolonged chloroform nar- 
cosis. 

2. Hepatogenous icterus is due to the free flow of bile 
from the liver becoming retarded (biliary stasis) and its pass- 
ing over into the blood (cholemia) via lymph vessels and tho- 
racic duct. The obstruction may have its seat in the biliary 
capillaries or larger ducts, and often at the ductus clwlcdocluts 
in the bowel. Hepatogenous icterus is characterized by the 
appearance of bile pigments in the urine while the feces, con- 
taining less than normal, are of too light a color. 

Hepatogenous icterus is seen in duodenal catarrhs with 
swelling and mucous obstruction of the ductus choledochus, 
tumors, parasites (ascarides) and concretions which block 
the bile flow. In lupinosis and phosphorous poisoning a swell- 
ing of the ducts and parenchyma of the liver occurs leading to 
the collection and absorption of bile. 

Malignant icterus ( icterus gravis ) has associated with it 
mental depression and slow heart's action due to the effect of 
■the cholic and other acids contained in bile. 

III. Swelling. Swellings of the conjunctiva usually 
are diffuse and may occur in both eyes. They are due to a 
serous infiltration of the mucosa and submucosa. If of an 
inflammatory character they are hot and painful. This con- 
dition finds its best development in influenza of the horse, 
the greatly swollen, glassy mucous membrane protruding from 
between the half-closed lids. It is seen further in contagious. 



■€2 CLINICAL DIAGNOSTICS. 

pleuropneumonia of the horse, purpura hemorrhagica, ma- 
lignant head catarrh of the ox, bovine pest, anthrax, dog dis- 
temper, chicken diphtheritis. 

The swelling may be due to hydremia, as in primary 
anemia and in cachectic diseases of sheep : liver fluke disease, 
lung and stomach worm plague. 

In the course of chronic diseases of the stomach and in- 
testines a slight swelling of the conjunctiva, attended with a 
washed-muddy and sometimes icteric discoloration, appears. 

The conjunctiva may be drier than normal in severe feb- 
rile diseases and bad colics. 

5. Bodily Temperature. 

The internal temperature of the body is maintained, with 
slight variation, at a definite elevation by means of an es- 
pecial regulating apparatus. The production of heat in the 
body and the loss of heat from the body are kept equal. If 
the temperature varies from the -normal, and this variation be 
preserved for a time, a disturbance due to disease is affecting 
the regulatory apparatus. 

The determination of the internal temperature is of great 
importance in the diagnosis of disease, for each deviation 
from the normal is to be considered a symptom of considera- 
ble moment. In all diseases affecting internal organs, the 
measuring of the temperature is imperative. 

Method of examination. Thermometry. Formerly the 
temperature was approximated by laying the hand upon dif- 
ferent parts of the body, namely the nose, ears, horns, extrem- 
ities, or by inserting the fingers into the mouth. Such methods 
require long practice before a reliable estimate can be ob- 
tained, and they are always deceptive. Only in exceptional 
cases are they now in vogue. The temperature is most ac- 
curately measured with a thermometer, graduated in degrees 
and tenths of a degree. [Except in America, England and 
perhaps one other country the Celsius (centigrade) thermom- 
eter is in common use. It is graduated into 100 degrees, and 



GENERAL PART OF EXAMINATION. 63 

these subdivided into tenths of a degree. In this country the 
Fahrenheit thermometer is generally used. It is graduated 
into 212 degrees, each degree being subdivided into fifths. 
Our preference for this latter instrument is largely tradi- 
tional, and it is being displaced by the centigrade, which is 
now almost universally employed in scientific work. 

The following simple formula will indicate how readily 
the Celsius scale may be converted into the Fahrenheit scale 
and vice versa: 

Fahrenheit = 9-5 C + 32. 
Celsius = 5-9 (F - 32)]. 

For veterinary practice a maximum thermometer should 
be used, preferably a tested or compared instrument. The 
thermometer should be inserted full length into the rectum, 
which gives the best results, though in exceptional cases the 
vagina is chosen. 

We should, of course, guard against being kicked by the 
animal, and exercise care that the instrument does not break 
and injure the mucous membrane. F>efore introducing the 
thermometer, the column of mercury should be shaken down. 
The use of water, saliva or oil facilitates insertion. We 
should allow the instrument to remain in the rectum from 
three to five minutes. 

Taking the bodily temperature once daily is of great 
value during the course of an internal disease ; in important 
cases the temperature should be registered twice a day (8 a. m. 
and 5 p. m.). After diagnostic inoculations (tuberculin, 
mallein), especially during the critical period, the temperature 
should be recorded at least every two hours. Thermometry 
is of great diagnostic importance during an outbreak of an in- 
fectious disease, the elevation in temperature being often the 
first symptom shown. By taking the temperature 
once daily (best at evening), the infected 
animals may be determined before further 
symptoms of disease develop: [influenza, 



64 



CLINICAL DIAGNOSTICS. 



contagious pleuropneumonia, swine plague 
or hog cholera, Texas fever], 

I. The Normal Temperature. The normal tempera- 
tures of the different animals are as follows : 

Horse . .37.5— 38.5° C. [ 99.5—101.3°: 



Ox .. 
Sheep 
Goat . 
Hog . 
Dog . 
Fowls 



. 38.0- 
.39.0- 
.39.0- 
.38.0- 



-39.0° 
40.5° 
-40.5° 
40.0° 



.37.5—39.0° 
.41.5—42.5° 



[100.4—102.2° 
[102.2—104.9° 
[102.2—104.9° 
[1004—104.0° 
[ 99.5—102.2° 
[106.7—108.5° 



The temperature will vary a few tenths of a degree in 
the same species, and slight variations may occur in one and 
the same animal within a single day. This latter variation 
may amount to 1° C. [1.8° F.]. 

In healthy but pregnant cows the temperature may vary 
1.5° C. [2.7° F.] ; a temperature elevation, therefore, of 
39.9° G. [103.8° F.] would not necessarily mean fever in 
these animals. 

When the organs (muscles, glands) are active a slight 
rise in temperature takes place, when at rest a slight sinking 
follows. 

From long continued exercise at a rapid gait the tem- 
perature of a horse may rise 2.5° C. [4.5° F.]. Two hours 
may elapse before it reaches normal again. 

High atmospheric temperatures or warm stables, inas- 
much as they reduce radiation, tend to increase the tempera- 
ture. As a rule the temperature is lower in the morning than 
toward evening. 

Age, race, sex, temperament and when eating have but 
little influence on bodily temperature. During the hot sea- 
son of the year, in cattle kept in stables the temperature may 
rise 1.0° C., for a short time. 

As a rule the bodily temperature is lowest in the morn- 
ing and in the afternoon at about five o'clock highest. 



GENERAL PART OF EXAMINATION. 65 

II. Temperature of the skin. The thinner and more 
vascular the integument and the finer 'the hair coat, the 
warmer the organ feels. Exposed surfaces of the skin feel 
cooler than more protected, covered parts. The ears and 
extremities, therefore, are normally colder than the rest of the 
body. 

The surface temperature is measured by laying our hands 
upon the skin. During fever the distribution of the bodily 
heat is often irregular, therefore it is not uncommon to find 
one leg .cold while its fellow may be abnormally hot ; in fever 
in the ox, the horns are sometimes hot and cold alternately. 
The taking of the surface temperature is only of value in the 
ox and dog, the use of the thermometer being more reliable 
in the other animals. 

The surface temperature is elevated (skin hot) in fever 
and during normal outbreak of sweat. It is reduced (skin 
cold) when the temperature is below normal (milk fever), 
collapse, during chill stage of fever and in the cold sweat 
which usually .precedes death. 

The temperature of the skin is unevenly distributed (one 
ear hot, the other cold, ends of ears very hot or very cold, 
legs cold) in fever. The horns of cattle frequently furnish 
an index to the temperature of the body. 

III. Fever. Although the character of fever is not 
expressed entirely by elevation of temperature, we have be- 
come accustomed to associate high temperature and fever, 
using the terms as if synonymous. As a matter of fact, the 
increased temperature is only one of the characteristic and 
most readily available symptoms in the complex phenomenon 
called fever. As a rule, however, there is a direct relation- 
ship existing between the height of the temperature and the 
degree of development of the fever. At times in the ox, the 
increase of temperature, as measured by the thermometer, 
fails to correspond with the degree of fever, which can be 
appreciated by the remaining symptoms. 



66 CLINICAL DIAGNOSTICS. 

Besides mere increase in temperature, the following phe- 
nomena attend fever : 

1. Chill. When the temperature of the body rises very 
rapidlv the peculiar symptoms of chill are shown : pronounced 
trembling of the muscles, which can shake the whole body, 
arched back, erect hair coat, cold skin. Chill is not a con- 
stant symptom of fever, occurring only in certain infectious 
diseases, such as anthrax, bovine pest, septicemia, pyemia, 
malignant head catarrh. [It is sometimes seen in animals 
reacting to tuberculin or mallein]. 

2. . Uneven distribution of the external temperature of 
the body. The ears, horns, nose and extremities are abnor- 
mally warm or cold, one extreme alternating with the other. 
The muzzle of the ox. the nose of the dog and the snout of 
the hog are dry, even creviced and alternately too hot or too 
cold. 

3. Acceleration of the pulse and respirations take place 
more slowly than the increase in temperature ; and they do 
not bear the same relationship to the temperature in all fevers. 
The higher the pulse frequency, the more serious the fever, 
the pulse becoming weak and the artery soft. 

4. Loss of appetite and impaired digestion. In fever 
the secretion of the digestive juices is lessened, peristalsis 
suppressed (constipation), thirst increased. 

5. Mental depression. 

6. Albuminuria. 

Although the variations in the normal temperature of a 
given animal are confined to narrow limits, when the tem- 
perature exceeds these limits we are not always justified in 
assuming the presence of fever. The physiological functions 
of the organs can momentarily become sufficiently accelerated 
to produce a degree of temperature in excess of the usual 
. normal one. The appearance of concomitant symptoms or 
repeated recording of the temperature will generally decide 



GENERAL TART OF EXAMINATION. 



67 



whether fever be present or not. In doubtful cases we speak 
of high normal temperature. 

The following temperatures may be safely assumed to 
indicate fever : 

In the horse a temperature of 39.0° [102.2° F.] and over. 
In the ox " L0.0° [104.9° F.] 

In the dog " 39.2° [102.5° F.] 

In the ox and dog fever is often present without a rise 
of temperature. In such cases we must depend upon the sur- 
face temperature and the other symptoms of fever present. 
Generally the height of the temperature expresses the 

Fig. 17. 
S b t 8 9 to I ti I a I tS \tf\tS \ ti | /> 




Stad. incre- 
ment! 



Fastigium. 



Stadium decrementi. 
Crisis 



Febris con/inwa— Equine Pleuropneumonia. 

height of the fever. Four degrees of fever are distinguished, 
which for the horse and dog are as follows : 

1. Mild fever 38.5°— 39.5° C. [101.3°— 103.1° F.]. 

Moderate fever 39.5° — 40.5° C. [103.1° — 104.9° F.l. 
High fever 40.5° — 11.5° C. [104.9°— 106.7° I\). 
Very high fever or hyperpyretic temperature 
41.5° C. [106.7° F.l and over. 

Usually in the horse even in the most severe infectious 
diseases, the temperature does not exceed 41.7° C. [107.0° 



2. 

3. 

4. 



G8 



CLINICAL DIAGNOSTICS. 



F.] ; only exceptionally, in tetanus, contagious pleuropneu- 
monia, and influenza, is this high mark passed. The highest 
temperature is carried by fowls, namely 43,5° C. [110,3° F.]. 
[In cases of "heat stroke" in horses hyperpyretic temperature 
may reach 110° F.]. 

During a single day a febrile temperature does not 
remain constant, but agreeing with the variations of the nor- 
mal temperature, is lower in the morning than toward even- 
ing — the so-called morning remissions and evening exacer- 
bations. 

Fig. 18. 




Febris remittens.— South African Horse Sickness. 



Recording of the variations in temperature which occur 
during the course of a disease is also of great importance. 
If the temperature is measured at a certain time daily and 
the record expressed in a graphic manner, the so-called fever 
curve is obtained. From the fever curve is recognized the 
type of fever present. 

In veterinary medicine the following types of fever are 
important : 

1. Continued fever, daily variation less than 1° C. 
(1.8° F.). 

2. Remittent fever, daily variation over 1° C. 



GENERAL PART Or EXAMINATION*. 



69* 



3. Intermittent fever, periodical temporary fall to nor- 
mal temperature. 

4. Atypical fever is one having- no regular character. 



41,0 



40,0 



39,0 



38,0 



87,0 




Apyrexia. Relapse. 

Febris intermittens -Flagelosis of the Horse. 

In the course of most infectious diseases, three stages are 
distinguished, according to the course of the fever, viz.: 



Fig. 20. 



41,0 
40,0 
39,0 
88,0 
37,0 





1 


i 


> 


3 


< 


i 


s 


i 




? 




( 




' 




u 


1 




« 


a 


1H Sf lb ft I 
















































r 














A 


































■ 












/ 


\ 


V 


-v 




=5 


















- 
























































S^^ii 
















































































































































. .. 



















































Initial Fever. 

Febris atypica— Strangles of the Horse. 



Relapse. 
Abscess developing' 



Fall 
after opening 
Abscess. 



70 CLINICAL DIAGNOSTICS. 

1. Stage of increasing temperature (stadium incre- 
menti). 

2. Acme, temperature at its highest (fastigium). 

3. Stage of falling temperature (stadium decrementi). 
A rapid fall of temperature (within 1-2 days) is called 

crisis, a gradual decline, lysis. 

According to duration we distinguish: ephemeral (one 
day), acute and chronic fevers. 

IV. Subnormal Temperature. Hypothermia. Like 
the high normal, the subnormal temperature may be physiolog- 
ical. Further, it may come from the fact that the sphincter 
ani is relaxed, or that the thermometer has not been inserted 
deep enough, or that the rectum is filled with feces, or that 
defecation takes place just before or during the insertion of 
the instrument. 

A subnormal temperature due to disease is uncommon. 
It is seen to occur, but not constantly, in parturient paresis, 
certain gastro-intentinal diseases of the dog, anemia, hemor- 
rhage, icterus gravis. A subnormal temperature is mo3t fre- 
quent in fatal diseases just before death (temperature of col- 
lapse). 

General Infectious Diseases. 

Septicemia. Nearly all forms of so-called "Blood Poisonings" 
are designated by the collective term Septicemia. Symptoms: 
suddenly appearing fever, often accompanied by chill; fever of the 
continued type; mucous membranes highly reddened, often icteric, 
frequently ecchymosed. Very rapid, small pulse. Food and drink 
refused; fetid diarrhea. Great mental depression, blank counte- 
nance, eyes sunken. Acute or peracute course. 

Pyemia is a general disease due to pits cocci gaining access to 
the blood, and is characterized by multiple, secondary abscess for- 
mation (pyemic metastasis) in the various organs, lungs, liver, 
kidneys, brain, joints, etc. Diagnosis is easy when primary abscess 
is available; otherwise it is difficult. As each new abscess forms 
the temperature increases, therefore it is fever of intermittent type. 
Mucous membranes are congested, icteric. Pulse is continued 
high. Course subacute. 



GENERAL PART OF EXAMINATION. 



71 



Anthrax is an acute infectious disease due to the Bacillus 
anthracis. Begins suddenly with high fever; tendency toward 
hemorrhages from mucous membranes. In the ox and sheep the 
course is often apoplectic; when course is acute it lasts 1-3 days. 
Brain symptoms, Fig. 21. 

convulsive twitch- 
ings of muscles, rap- 
id pulse, dyspnea, 
loss of milk, are 
symptoms some- 
times seen. In horse, 
colic symptoms oc- 
cur. Formation of 
anthrax carbuncle in 
skin is not rare in 
the horse. In hog, 
symptoms of severe 
laryngo - pharyngitis 
with swelling pre- 
dominate. Diagnosis 
is positive only after 
finding bacilli under 
the microscope. An 
anthrax slide is made 
as follows: A thin 
layer of blood or 
















Anthrax bacilli Stained according to Olt's method. 
a. b., Cadaver bacilli. 

spleen pulp is smeared over a slide, passed three times through 
the flame of a Bunsen burner, then covered with a 2% watery 
solution of safranin and allowed to boil by holding over a Bunsen 
flame for a few moments. Wash and examine. 

The anthrax bacilli are from 1 to 2 times as long as the diame- 
ter of a red blood corpuscle, and are composed of from 2 to 8 
bacterial cells, which are stained, reddish brown on the slide. Each 
bacterial cell is cylindrical, slightly longer than broad, appearing 
almost square in form. The ends are plane or somewhat convex. 
The bacterial cells are surrounded by a gelatinous capsule, which 
is stained yellow in the preparation, and which joins the cell3 
together to form the bacillus. The capsule is bounded by a dark 
line. If the bacilli come in contact with one another they unite, 
their capsules blending together. 

Influenza. An acute, infectious disease of the horse, very 
easily transmitted. Period of incubation 5 to 7 days. First symp- 
tom is a rise in temperature which continues 3 to 6 days, then 
crisis. Great debility, slow gait, staggering, great mental depres- 
sion, head held down or rested on manger, eyelids and conjunctiva 
swollen, hot, painful, photophobia. Pulse at first strong, little 
affected, later accelerated. Loss of appetite, diarrhea in about 
3 days. Tn later stages cold, painless edematous swelling of the 
extremities. Mortality 4%. 

[Swine Plague and Hog Cholera. Infectious diseases of swine, 
caused by bacilli which enter the body through the respiratory 
tract (swine plague of Smith), or via respiratory tract or mouth — 



72 CLINICAL DIAGNOSTICS. 

with food and water — (hog cholera of Smith). Period of incuba- 
tion 4 to 21 days. Young pigs most predisposed. One attack pro- 
duces immunity in most cases. Symptoms: apoplectic form; die 
very suddenly or after a few hours illness (beginning of an out- 
break). Usual form: fever, temperature 107°-108°F., appetite im- 
paired, tremblings of muscles, unwillingness to move, stupid, dull, 
hide in litter. Bowels at first constipated; later diarrhea. Eye- 
lids filled with mucus. Respiration accelerated, labored; painful, 
frequent cough. On pendant parts of body, skin is reddened, con- 
gested; eczematous eruptions, ulceration of skin. Rapid loss of 
flesh, unsteady, tottering gait. Death within 48 hours to 2 weeks. 
Mortality 20-100%. 

Texas Fever. An infectious blood disease of the ox caused 
by a protozoon (Pyrosoma bigeminum) which enters and destroys 
the red blood corpuscles. The disease is spread by the cattle tick, 
Boophihis bovis, the younger generation of which carries the pro- 
tozoon. Period of incubation 13-90 days after exposure to tick- 
infected places. Symptoms: fever (104°-109° F), unnatural recum- 
bent positions and standing attitudes; animal is dull, stupid; in 
some cases shows vicious tendencies; horns, ears, and hoofs are 
hot. Pulse is rapid; dyspnea; constipation, excreta tinged with 
bile. Visible mucous membranes icteric. In later stages urine red. 
Ticks of various size to be found on escutcheon, inside of thighs, 
base of udder or scrotum. Little blood flows from intentional 
wounds. Characteristic post-mortem changes. Duration 3 days 
to several weeks. Mortality 20-90%]. 

Fowl Cholera. Period of incubation 1 day. Apoplectic death 
common. Great exhaustion, staggering, foamy mucus discharged 
from bill, dyspnea with respiratory sounds, loss of appetite, 
diarrhea, bacilli as in Wild und Rinderseuche (wild and cattle 
plague). 

Braxy of Sheep. A peracute hemorrhagic inflammation of 
the abomasum due to the bacillus gctstromycosis ovis. In many 
respects resembles anthrax. 

South African Horse Sickness. A non-contagious (though 
readily transmittable by blood inoculation) disease of horses and 
mules. Incubation 7 days. Slowly rising fever with morning 
remissions. Symptoms of pulmonary edema (Dumperre zickte) 
or swelling of the head (Dikkop). Great muscular weakness, ani- 
mals recumbent. Pulse not very rapid but small. Mortality 80- 
90%. 



B. The Special Part of the Examination. 

6. Circulatory Apparatus. 

An examination of the circulatory apparatus is of impor- 
tance not only to diagnose those maladies which affect the 
organs carrying the blood, but also from the fact that all 
acute general or infectious diseases of a serious character 
influence more or less greatly the circulation. 

A methodical examination of the organs carrying the 
blood includes : 

i. Taking the pulse. 

ii. Noting the condition of the peri- 
pheral blood vessels. 

in. Examining the h e a r t . 

I. Pulse. 

Method of Examination. The pulse is felt with the fingers, 
which may be gently rested upon any d? the superficial arteries 
having bone or other hard tissue under them. In the horse and 
ox the sub-maxillary artery is most commonly used, in the latter 
animal the artery is easily felt on the lateral side of the jaw bone. 
Other arteries wrfiich may be used to take the pulse are the radial, 
plantar, temporal, transverse facial and coccygeal. In the dog! 
sheep, goat and cat the femoral artery, is most available. [In 
clogs and cats the brachial artery can be felt on the medial sur- 
face of the humerus, just in front of and above the elbow]. In 
tin- hog and fowl the pulse can not usually be felt, hence the 
heart's beat is used. 

From a clinical standpoint the 1. Frequency, 2. Rhyti 
and 3. Quality, are of importance to consider in examining 
the pulse. 

a. Frequency. By the frequency of the pulse 
wc mean the number of blood-waves (beats) felt in a 
minute's time. There is a great variation in the normal 



74 CLINICAL DIAGNOSTICS. 

frequency, not only in the different species of animals, but 
also in animals of the same kind. Many physiological con- 
ditions have great influence upon the pulse-frequency : size, 
age, sex, race, atmospheric temperature, time of day, pre- 
hension or digestion of food, exercise, excitement, are all 
factors. 

Large animals carry a slower (less frequent) pulse than 
small ones; adults slower than young; females higher (more 
frequent) than males ; well bred individuals, slower than 
mongrels ; in summer the pulse is higher than in winter ; in 
the morning slower than toward evening ; excited animals 
show a more rapid pulse than animals standing at perfect rest. 
In nervous animals (horses and dogs) the act of taking the 
pulse often increases its frequency. 

Taking these physiological variations into consideration, 
the following is the average pulse-frequency for the dif- 
ferent animals. 

1. Horses in general 28 — 40. 

Warm blooded stallions 28— 32. 

Cold blooded stallions 28— 36. 

Colts, two weeks old — 100. 

" four weeks old — 70. 

" six to twelve months old 45 — 60. 

" two to three years old 40 — 50, 

2. Asses and mules 45 — 50. 

3. Bovines 40— 80. 

4. Sheep and goats 70 — 90. 

5. Swine 60—100. 

6. Dogs 60—120. 

7. Cats 110—130. 

8. Fowls 120—160. 

In regard to frequency we distinguish a slow pulse 
(pulsus rams) and a rapid pulse (pulsus frcqucns). 

The slow pulse (pulsus rarus) is very uncommon. It 
most often accompanies brain diseases attended by great de- 
pression (chronic and subacute hydrocephalus, tumors in the 
brain), icterus gravis, and poisoning from alcohol or lead. 



SPECIAL CLINICAL EXAMINATION. 75 

In the horse at times it is seen in gastro-intestinal affections 
with loss of appetite, probably due to some alteration in the 
sympathetic nerve. 

Fig. 22. 




Slow, Sluggish Pulse of Horse. 
Taken with Marey's Sphygmograph--Art transversa faciei. 

The fast pulse (pulsus frcqucns) is very common in dis- 
ease. A very rapid pulse, though characteristic of no special 
disease, is always a sign that the parenchyma of the heart is 
affected, hence in severe diseases it is an index to the heart's 
strength. Rarely in the horse does the pulse frequency exceed 
80 beats per minute; if it exceed 100, the prognosis is unfa- 
vorable. In the ox a pulse of 100, and in the dog one of 120- 
150 denotes severe illness. 

An abnormally accelerated pulse occurs : 

1. In all severe diseases, especially when attended by 
fever. The frequency of the pulse, however, does not always 
bear the same relationship to the height of the temperature; 
whether the pulse be accelerated or not depends upon the 
fever's effect upon the heart, which differs with the disease 
present. In contagious pleuropneumonia of the horse, septi- 
cemia, anthrax, and severe inflammations of the bowels and 
peritoneum, the pulse rate corresponds to the height of the 
fever ; in influenza and in strangles, the acceleration of pulse 
is not marked, compared with the temperature. 

2. In painful conditions (severe injuries, fractures of 
"bones, abscess in hoof, etc.). 

3. In mental excitement (fear, anxiety). 

4. In severe hemorrhage. 

b. Rhythm. When the individual pulse beats are sep- 
arated by intervals of equal duration, the pulse is regular 



76 CLINICAL DIAGNOSTICS. 

(pulsus rcgularis). In the dog and, according to Cadeac, 
frequently in mules and asses, the pulse is often irregular and 
intermittent. 

Fig. 23. 




Normal Pulse— Horse. 
Marey's Sphygmograph — Art. trans, faciei. 

The rhythm of the irregular and of the intermittent pulse 
is abnormal, i. e., arhythmic. 

When the pulse is irregular the intervals between the 
individual pulse beats are of unequal duration. 

This is due to lack of innervation of the heart, as well, 
as to exhaustion of the organ. If the pulse of the horse 
exceeds SO it is usually irregular. Irregularity is also ob- 
served in valvular diseases of the heart, and in myocarditis. 

The pulse is intermittent when a beat fails now and 
then. When regularly intermittent, a certain beat can not 
be felt, as for instance, every fourth or fifth pulse wave ; when 
irregularly intermittent there is a lapse which does not occur 
between any certain beats. Sometimes the heart's beat is 
synchronous with the intermittency of the pulse; at other 
times the heart's beat is normal, the intermittency occurring 
only in the peripheral vessels. To determine this the radial 
pulse and heart's beat can be compared. 

The intermittent pulse is commonly physiological, and 
seen in perfectly healthy horses and dogs, where it disappears 
after exercise and, therefore, probably due to lacking innerva- 
tion. Pathologically it appears in chronic hydrocephalus 
(dummies), severe gastric troubles, and during convales- 
cence from infectious diseases which have occasioned high 
pulse (contagious pleuropneumonia of the horse). 



SPECIAL CLINICAL EXAMINATION. 77 

c. Quality. The pulse beats should be of equal vol- 
ume. When this is true we speak of an equal pulse (pulsus 
uequalis): 

The quality of the pulse varies with the kind of animal. 
The normal size, strength and hardness of the 
pulse can only be learned by experience ; it can not be defined. 
In the horse the pulse is large, strong and the artery only 
moderately tense ; in the ox the pulse is smaller, not so strong 
but the artery is tenser and may be rolled under your finger 
like a hard rubber tube. In small animals the pulse is quick, 
strong and hard. (See 74.) In dogs often it is inequal. 

According to whether a greater or smaller quantity of 
blood is forced into the arterial system, we distinguish a 
full (pulsus magnus) and an empty (pulsus parvus). 

The pulse becomes empty when much accelerated and in 
severe hemorrhages. In fatal diseases the pulse finally be- 
comes imperceptible (pulsus iuscnsibilis), indicating cardiac 
weakness or anemia. 

Fig. 24. 




Small, Irregular and Inequal Pulse of Horse. 
Marey's Sphygmograph. 

If the pulse waves are not of equal volume the pulse is 
•called inequal (pulsus maequalis) . This is a very impor- 
tant symptom of cardiac weakness, where it is uniformly 
associated with irregularity, and of valvular (mitral) heart 
disease. At times there exists a close relationship between 
an irregular and an inequal pulse. A small wave follows 
closely a larger one, so that there is a regular alternation of 
weak and strong beats. It denotes beginning heart's weak- 
ness. 



78 CLINICAL DIAGNOSTICS. 

By the strength of the pulse we mean the force with 
which it lifts the finger palpating it. We distinguish a 
strong (pulsus fortis) and a weak (pulsus dcbilis). In 
hypertrophy of the heart the pulse is strong; in parenchyma- 
tous degeneration of the cardiac muscle, it is weak. The 
degree of weakness shown by the pulse indicates the severity 
of the attack. We form an estimate of the strength of the 
pulse by noting whether it is readily compressible or not. 

The hardness of the pulse is due to the distention of the 
arterial wall and is greatest at the acme of a wave. The 
pulse is hard (pulsus durus) in severe pain, peritonitis, tetanus 
and acute brain diseases, fin inflammation of serous mem- 
branes generally the pulse is hard]. The opposite of a hard 
pulse is the soft pulse (pulsus mollis). 

Besides the above the following kinds of pulse deserve 
mention: Trembling pulse (p. trcmulus), where the wave 
in the distended artery is so small that only a slight trembling 
can be felt. Thready pulse (p. iiliformis) is one which is so 
small, weak and soft as to be hardly -perceptible. If asso- 
ciated with this pulse the visible mucous membranes are 
cyanotic, it shows deficient heart's strength and justifies a bad 
prognosis. The wiry pulse is a small, tense and very hard 
pulse. Occurring in colic it is a bad sign. A less marked 
wiry pulse may be noted in aortic stenosis and in chronic 
nephritis. 

The arch of the pulse wave may become changed in dis- 
ease. If the wave is very abrupt, we speak of a hopping, 
swift pulse (p. cclcr) ; if. on the contrary, the wave is much 
prolonged, it is spoken of as a "sluggish" pulse (p. tardus). 

A quick pulse (p. cclcr) is associated with mild cases 
of cardiac hypertrophy, plainly marked in aortic insufficiency. 
In the latter case it is due to the regurgitation of the blood, 
which occurs at systole, into the hypertrophic left ventricle. 
In both these instances the pulse is full and strong. Remark- 
ably in heart's weakness a p. cclcr is present. However, here 



SPECIAL CLINICAL EXAMINATION. 79 

the pulse is weak and the'artery empty. The "sluggish" pulse 
(p. tardus) is noted in very lymphatic horses and is character- 
istic only of aortic stenosis, when it is at the same time 
small. 

A peculiar pulse is the dicrotic pulse where two marked 
expansions can be felt in one beat of the artery. It is seen 
in cases of lowered arterial tension combined with weak- 
ened heart's action, and is, therefore, noted in long continued 
fevers and in all forms of anemia. 

Fig. 25. 

Dicrotic Pulse — Horse. 
Marey's Sphygmograph. 

II. Examination of the Peripheral Blood Vessels. 

Arteries. A strong pulse attending wasting disease 
and emaciation calls for an examination of the small super- 
ficial arteries. An abnormally strong pulsation in the peri- 
pheral arteries of small caliber is visible in the horse in the 
branchings of the external maxillary artery. 

It appears in hypertrophy of the left ventricle especially 
when the bicuspid valves are defective. 

Veins. The state of distention of the veins is 
of primary interest. The veins become prominent after any 
acceleration of the heart's action in thin-skinned, fine- 
haired horses ; the condition, which is physiological, being a 
temporary one. A permanent distention of the veins is path- 
ological, and is due to an obstruction of the free flow of blood 
to the right heart. It is mostly plainly visible in the jugulars 
and their plexus on the head, other superficial veins (external 
thoracics, milk veins, veins of the extremities) showing it 
less on account of the edema usually accompanying the con- 
dition. 



80 CLINICAL DIAGNOSTICS. 

The jugulars can be distended to the size of the human 
wrist, or even the arm, appearing as great, round strands. 
The veins of the conjunctiva can also be distended, being rec- 
ognized as ramiform, often contorted, bluish strands in the 
mucous membrane. 

The veins are generally distended : 

1. In valvular disease (tricuspid). It is usually sec- 
ondary, but in the ox mostly primary. 

2. In chronic pulmonary diseases interfering with cir- 
culation : emphysema. 

3. In diseases of the heart's muscle, the organ having 
become so weak that it is unable to handle the quantity of 
blood : traumatic myocarditis of the ox. 

4. From excessive intrathoracic pressure upon the heart 
and large blood vessels : tympanitis, pleuritis, pericarditis 
traumatica of the ox. 

Pulsation in veins. Besides being distended, veins 
can show pulsation under some circumstances. Synchronous 
with the respirations, and independent of the heart's action, 
a slight swelling of the jugulars occurs during the act of 
expiration, to fall again at inspiration. A so-called jugular 
pulse is normal in the ox for the following reasons : The 
jugulars and anterior vena cava in this animal are compara- 
tively large. The continual flow of the venous blood into 
the right heart suffers during the systole of the right auricle, 
which slightly precedes that of the ventricle, a momentary 
interruption, the blood congesting in the anterior vena cava 
and jugulars, causing a brief distention of the jugulars, sim- 
ulating a pulsation. It is therefore not an active pulsation, 
but merely a passive undulation due to a regurgitation of the 
blood in the form of waves. The presystolic appearance of 
the pulse movement characterizes it, therefore it should al- 
ways be compared with the arterial pulse. The collapse of 
the vein is synchronous with the arterial pulse. 

The undulation of the jugular vein is intensified in the 



SPECIAL CLINICAL EXAMINATION. 81 

ox and becomes apparent in other animals when the above 
cited condition prevails, induced by a morbid congestion of 
the blood at the heart. In the horse the venous pulse is seen 
near the aperture of the thorax (lower portion of the neck). 
A true (positive) venous pulse is pathological. It is 
coincident with the heart's systole, and is produced by a de- 
fective closing of the auriculo-ventricular valves, the blood re- 
gurgitating into the auricle. True venous pulse is 
a characteristic symptom of tricuspid in- 
sufficiency. 

Fig. 26. 



WWWv 



Venous Pulse— Horse. 

The valves in the jugulars do not prevent the flowing 
back of the blood, as they are commonly not well developed, 
and if the vein be greatly distended they cannot close the 
lumen of the vessel. 

III. The Heart. 

The heart is examined by p a 1 p a t i o n , percussion 
and auscultation. 

Anatorpical. Tn all domestic animals the heart lies in the ven- 
tral portion of the thoracic cavity between the third and sixth 
ribs, in the dog extending to the seventh rib. The great mass 
of the organ (3-5) lies to the left of the median line, so that it 
approaches nearer the left thoracic wall than the right one. It 
does not occupy a perpendicular position, but an oblique one 
directed from the right, in front and above to the left, backward 
and downward, the left side of the apex reaching the chest wall. 

Horse. The base of the heart lies below the upper half of 
the height of the chest cavity, resting against the thoracic wall 
between the 4th and 5th intercostal space. The point of contact 
occupies a surface of about 10 cm high and 6-8 cm broad. (See 
Fig. 27, page 87). 

Ox and small ruminants. The heart is smaller and 
does not extend quite as far back as the 6th rib, its base, however, 
extends to the median line of the chest. Between the 4th and 5th 



82 CLINICAL DIAGNOSTICS. 

ribs it comes in immediate contact with the thoracic wall. (See 
Fig. 26.) 

D o g. The heart is of rounder form and lies very obliquely, 
touching the chest wall along a narrow strip from the 4th to the 
7th ribs. The apex is below the 6th intercostal space. (See 
Fig. 27.) 

Palpation of the heart's region. The beat of the heart can 
be felt by laying the flat of the hand over the cardiac region. 
Inasmuch as the anconeus muscles partly cover the region, the 
hand should be placed between them and the chest wall. In 
the depths a dull thud will be felt, produced by the thumping 
of the heart against the chest wall. The beat is due to a con- 
traction of the heart's muscles which causes a slight torsion of 
the organ to the left, bringing the left side, not the apex, 
in contact with the wall of the chest. The beat can best be felt 
in all animals just at the 5th intercostal space at the union of 
the ribs to the cartilages of the sternum. The force with which 
the beat can be felt depends upon the condition of the animal 
as to flesh, it being more plainly marked in thin animals, and 
just after severe exercise or excitement. Only in the dog can 
the heart's beat be felt normally on the right side. 

The force of the heart's beat can be increased 

or diminished. When the force of the beat is much increased 

a palpitation of the heart is spoken of. It occurs: 

1. In hypertrophy of the heart (here combined with 
strong pulse). 

2. In heart's weakness, the muscles of the organ un- 
dergoing spasm-like contractions incapable of properly pro- 
pelling the blood to the periphery, the pulse being small. The 
condition is seen in acute myocarditis, endocarditis and peri- 
carditis. 

3. Where the lung between the heart and the chest wall 
becomes thickened. 

The heart's beat is weakened: 

1. Where the force is enfeebled from degeneration of 
the heart's muscle. 

2. Where the heart is crowded away from the chest 
wall by accumulations of exudate in the thoracic cavity 
(pleuritis, pericarditis), or in some cases of pulmonary em- 
physema or tumors. 

Percussion of the heart. Except in very thin animals 
(horses) the percussion of the heart is of no great value in 



SPECIAL CLINICAL EXAMINATION. 83 

the diagnosis of disease, the reason being that with the per- 
cussion hammer we are unable to determine the boundaries 
of the organ, the adjacent lung tissue so modifying the sound 
that the merging of the dull sound of the heart's percussion 
into the full sound of the lung's is a very gradual one. 

Horse. In the horse, under favorable circumstances, in the 
region of the 4th and 5th intercostal space a zone of dullness 
about the size of a hand can be brought out by percussion. Its 
boundaries, however, are generally indefinite. 

Ox. Although the chest walls are thinner in this animal, the 
heart is covered more by the lungs than in the horse. 

Dog. A narrow horizontal line of dullness between the 4th 
and 7th ribs can be determined by vigorous percussion. 

The zone of cardiac dullness is in- 
creased in hypertrophy of the heart and where fluids col- 
lect in the pericardium ; tumors and thickenings of the lungs 
also induce it. 

The zone of cardiac dullness is some- 
times decreased from pulmonary emphysema. 

A tympanitic tone on percussion over the cardiac 
region is obtained in traumatic pericarditis of the ox, gases 
of putrefaction accumulating in the pericardium. 

The percussion of the cardiac region causes the animal 
pain in pleuritis and pericarditis. 

The Auscultation of the Heart. 

Method. The auscultation of the heart may be practiced by 
placing the right ear just behind the left elbow, the leg being 
drawn forward. Small animals may be laid upon the table and the 
phonendoscope used. 

Physiology. In the cardiac region and in the neighborhood of 
the same, we hear at each action of the heart two tones. One 
of these tones appears at the moment the organ contracts {sys- 
tole), and the second tone, which quickly follows the first, at the 
dilation of the organ (diastole). The second tone follow- SO 
closely the first one that it is difficult to differentiate between 
them, except in animals which carry a pulse below 00. Tn ani- 
mals which have rapid pulse it may be necessary to compare the 
pulse at a peripheral artery with the heart's beat. 

The origin of the heart-tones is still subject to dispute, the 
authorities not agreeing. 



84 CLINICAL DIAGNOSTICS. 

[The first heart-sound (the systolic) is caused by the con- 
tracting muscles of the organ and the closing of the auriculo-ven- 
tricular valves. The second sound is produced by the closing of 
the semilunar valves]. 

The first sound in our domestic animals is duller, deeper, 
more prolonged and usually louder than the second one, which 
is short, not so- deep, well defined (sharper), not so loud, and 
at times slightly metallic. There is a great variation in the 
sound produced by the heart in the different animals, and even 
in animals of the same species, the sounds being in one case 
sharper (more metallic) and in another deeper and duller. 
The thickness of the chest walls is also of influence, in ani- 
mals with well muscled chests the sounds are seemingly more 
muffled, duller. By pronouncing the syllables lub-dub one can 
mimic the sounds of the heart. 

I II I II 

lub dub lub dub 

Change in Heart-Sounds Due to Disease. 

Both sounds are increased in: 

1. Hypertrophy of the heart, the valves remaining in- 
tact, (idiopathic hypertrophy). 

2. Anemias. 

3. A thickening of the lung tissue around the heart, 
producing a better conductor of sound. 

The second sound only is increased: 

When the arteries are greatly distended, not infrequently 
the result of a congestion of the pulmonary circulation com- 
bined with hypertrophy of the heart. 

Both sounds are weakened when the normal heart be- 
comes enfeebled through disease of its parenchyma, or where 
the hypertrophic organ is exhausted. 

Metallic tones occurring during systole are very com- 
mon in anemic animals. In traumatic pericarditis of the 
ox, the pericardium containing gas, a loud metallic tone is 
heard at each systole when the heart-muscle is still vigorous. 



SPECIAL CLINICAL EXAMINATION. 85 

Sometimes the sound can be plainly heard the distance of 
several paces from the affected animal. 

This is due to the accumulation of gas in the pericardium 
acting as a resonant mechanism which augments the sound. 

The first tone is dull in heart's weakness and in myocar- 
ditis, especially noticeable in acute infectious diseases. 

A splittin g ||— - — | — — ~| or doubling |— -• I — —~| of the 
heart sounds, the condition of the circulatory apparatus being 
otherwise normal, is of no significance. Commonly the first 
sound is preceded by a short tone ~|-< — -| , which is pro- 
duced by the contracting of an unusually well developed 
auricle. 

Heart bruits. Heart bruits are abnormal 
sounds and are therefore pathological. They are caused 
by the sound producing parts of the organ vibrating for too 
long a time. Endocardial bruits and pericardial bruits are 
distinguished. 

a. Endocardial bruits (noises) come from 
within the heart and are closely connected with the heart 
sounds. We can distinguish, therefore, systolic bruits and 
■diastolic bruits, depending upon whether they occur at the 
first or second sound. If the bruits are produced by anatomi- 
cal changes of the heart itself, they are called organic, other- 
wise inorganic. 

a. The organic or endocardial heart bruits are caused 
either by a narrowing (stenosis) of the auriculo-ventri- 
cular or arterial openings or by alterations on the valves pre- 
venting them from closing properly (insufficiency). 
They form most valuable symptoms in the diagnosis of heart 
diseases. 

In stenosis the bruit occurs at the moment 
the blood passes the contracted orifice, the 
walls of which are set in vibration. If the stenosis involves 
the auriculo-ventricular opening the bruit occurs at diastole, if 
in the arterial openings, at svstole. 



86 



CLINICAL DIAGNOSTICS. 



In insufficiency the bruit occurs at the 
moment at which the valves should close. In 
consequence of their inability to close a regurgitation of the 
blood takes place, which produces a renewed vibration of the 
valves, and gives a bruit. If the insufficiency involves the 
auriculo-ventricular valves, the bruit occurs at systole ; if the 
semilunar valves are insufficient the bruit appears at diastole. 

The character of the bruits is varied, they can be buz- 
zing, blowing, purring, hissing, humming, sawing, rattling, 
long or short tones. Insufficiency bruits are generally softer 
than those due to stenosis. Heart bruits are made more 
pronounced by an acceleration of the heart's action, therefore 
the patient should be exercised before examination. 

Gmelin recommends digitalinum vcrum subcutaneously to 
bring out more distinctly heart sounds or casual bruits. The 
dose for the horse and ox is 0.025 — 0.05 ; for the dog 0.003 
0.009. The digitalin is first dissolved in 5ccm of 50% alcohol 
and then diluted with 20ccm of water. 



Systolic bruits 



Insufficiency 
of an auric- 
ulo- ventric- 
are characteristic of: -j ular valve. 
Stenosis of 
an arterial 
opening. 



Diastolic bruits! — ^~ I are characteristic of : ■ 



Stenosis of 
an auricu- 
lo-ventricu- 
lar opening. 
Insufficiency 
of a semi- 
lunar valve. 



SPECIAL CLINICAL EXAMINATION. 



87 



Although the bruits originate in different parts of the 
heart, the exact point of origin cannot be determined by 
auscultation. In the horse and dog valvular lesions have their 
seat most commonly in the left heart, rarely are they primary 
in the right heart. In the ox valvular diseases of the right 
heart are more frequent than of the left one. The auriculo- 



Fig. 27. 



XV- 




h 



Points at which Endocardial Bruits are most pronounced. 
a. b.— Line of Shoulder. 1.— Left Auriculoventricular Opening. 2. — Portal. 

monary Artery. 



3.-Pul- 



ventricular valves are more commonly diseased than the semi- 
lunar. 

b. Contrary to the endocardial, organic bruits, the 
inorganic or anemic bntits occur without that any discernible 
anatomical alteration appears at the orifices or valves of the 
heart. Inorganic bruits are systolic, soft, blowing and not 
constant {accidental) . They tend to disappear and reappear 



88 CLINICAL DIAGNOSTICS. 

again. Their origin is not well understood. They are nearly 
always noted in anemic animals. 

It is very important to distinguish between or- 
ganic and inorganic heart bruits, but in practice 
this is often very difficult. As a rule, soft, systolic bruits 
(they do not occur during diastole) should be very carefully 
estimated. Organic heart bruits are always accompanied by 
hypertrophy and often alteration of pulse, and frequently 
venous congestion. 

b. The pericardial bruits. . These bruits do 
not come from within the heart itself, but are extra-cardial. 
They consist in frictional noises due to the pericardium having 
become so altered that its surface is no longer smooth and 
slippery, but rough and dry. The bruits are characterized by 
being scratching, grating or rubbing, frictional tones not in- 
timately related to either systole or diastole. Pericardial bruits, 
when present, muffle the regular heart sounds. 

A pericardial metallic gurgling or liquid bruit, synchron- 
ous with the heart's beat, occurs in the course of traumatic 
pericarditis when fluid exudate and gas commingle in the per- 
icardium. 

Diseases of the Circulatory Apparatus. 

Acute myocarditis. A diffuse parenchymatous affection of the 
heart's muscle which attends severe infectious diseases. Symp- 
toms: great weakness and debility, mucous membranes cyanotic, 
high fever, heart's beat weak, systolic sound muffled. Pulse very 
rapid up to 120 in the horse; small, weak, arhythmic, inequal, 
finally imperceptible. Course acute or peracute. Mortality high. 

Hypertrophy and dilatation of the heart. Can be present for 
years without visible symptoms occurring. Symptoms: Pulse 
strong, also heart impulse, zone of cardiac dullness enlarged on 
percussion. Later when the heart is greatly dilated and the valves 
can no longer close sufficiently, symptoms of bicuspid insufficiency 
occur; pulse rapid, arhythmic, inequal; heart's beat sometimes 
palpitating, increased dullness on percussion. Systolic blowing 
bruit, diastolic sound intact or louder than normal. Exercise 
causes dyspnea from pulmonary venous congestion. Termina- 
tion as in chronic valvular disease. Most common heart disease 
of horse and .dog. 



SPECIAL CLINICAL EXAMINATION. 89 

Acute endocarditis. Not very common. Fever, greatly ac- 
celerated heart's action, irregular pulse, intermittent, very small. 
Heart sounds are at first normal, later systolic bruit. Dyspnea. 
General condition altered. Prognosis unfavorable. 

Valvular disease, chronic endocarditis. Caused by a chronic 
valvular endocarditis which leads to an atrophy of the valves 
(insufficiency) or to a narrowing of the orifices (stenosis). Fol- 
lowing valvular failure a hypertrophy of the ventricle always takes 
place; in disease of the semilunar valves the left ventricle, in 
defects of the mitral valve a hypertrophy of the right ventricle. 
The hypertrophy of the ventricle, which is combined with dila- 
tation, is compensatory. 

Bicuspid (Mitral) insufficiency. Most common form 
of heart disease in dogs and horses. Pulse small, irregular. Sys- 
tolic bruit. Diastolic sound clear, loud. Dyspnea on exercise. 

Stenosis of the bicuspid (Mitral) valves. Rare 
when unattended with insufficiency; an uncommon lesion com- 
pared with insufficiency. Pulse small and very weak. Diastolic 
and pre-systolic bruits. Great dyspnea. 

Insufficiency of the tricuspid valves. Rarely 
primary in the horse, mostly secondary to diseases involving the 
left ventricle, leading to hypertrophy of the right heart. In the 
ox frequently primary. Systolic bruits, venous congestion, venous 
pulse. 

Stenosis of the tricuspid valves. Happens only 
in the ox and is then combined with insufficiency. Diastolic bruits, 
great venous congestion, dyspnea. 

Insufficiency of the aortic semilunar valves. 
Full, strong, hopping pulse, pulsation in peripheral arteries. 
Diastolic bruit. Hypertrophy of the left heart. 

Stenosis of the aorta. Mostly combined with insuf- 
ficiency. Harsh systolic bruit. Long-drawn-out, slow, small pulse 
(28-32 in the horse). Hypertrophy, attacks of vertigo during exer- 
cise (work). 

Valvular diseases of the pulmonary artery 
are very rare. 

Termination of all valvular diseases. In 
chronic heart diseases the dilatation of the ventricle is followed by 
a relative insufficiency of the valves. Semilunar defects lead to 
a relative insufficiency of bicuspids; bicuspid defects to a relative 
insufficiency of the tricuspids. The special diagnosis of the pri- 
mary lesion is then very difficult. As sequela, finally, the follow- 
ing symptoms appear: small, irregular pulse, systolic and diastolic 
bruits, congestion of veins, venous pulse, edemas, dyspnea, 
albuminuria, dropsy, attacks of vertigo, emaciation and great 
weakness. 

Pericarditis. Mostly a symptom of other diseases. Moderate 
fever, congestion of mucous membranes. Pulse rapid, heart's 
beat weak or imperceptible, zone of cardiac dullness increased, 
pericardial (frictional) bruits, which disappear when fluid exudate 



90 CLINICAL DIAGNOSTICS. 

becomes prevalent. The pressure of the exudate upon the veins 
causes congestion in jugulars (venous pulse). 

Traumatic pericarditis of the ox. Begins usually with the 
symptoms of an acute indigestion (traumatic inflammation of the 
stomach and diaphragm), which may continue for some time. If 
the pointed foreign body is driven forward, which is commonly 
caused by the expulsive efforts of the abdominal muscles during 
the act of parturition, it usually reaches the heart. The general 
condition of the patient is greatly disturbed, the expression com- 
plaining, anxious. The animals stand with back arched and held 
stiffly, do not like to lie down, and when recumbent rest con- 
tinually on the sternum. When arising they utter complaints. 
Temperature variable, external (surface) temperature never quite 
normal. Pulse rapid, artery tense. Heart beat cannot be felt, 
zone of cardiac dullness increased and tympanitic when gas has 
accumulated in the pericardium. On auscultation in the earlier 
stages pericardial frictional bruits, heart sounds clear, when much 
exudate is present weak; systolic bruits of a metallic character 
in consequence of spasm-like contractions of the heart. When 
putrefactive gases are present the heart sounds can be so loud 
and metallic as to be heard at a distance. Jugulars distended,, 
pulsating (undulating), edema of brisket, neck and throat. Course 
chronic notwithstanding severity of the ailment. Prognosis bad. 

7. Respiratory Apparatus. 

The examination of the respiratory- 
tract is one of the most important re- 
sponsibilities of the veterinarian, first 
because it is frequently subject to disease, and secondly from 
its availability to thorough inspection. 

From the complex anatomy of the apparatus, and the 
value to diagnostics of the varied clinical phenomena it mani- 
fests in disease, a searching examination of the respiratory 
tract can only be made by following a definite system. 

The examination would include attention to the following: 
I. The respiratory movements (res- 
pirations). 
II. The breath. 

III. The nasal discharge. 

IV. The nasal cavities and adjacent 

sinuses. 
V. The submaxillary lymph glands. 



RESPIRATORY APPARATUS. 91 

VI. The cough. 

VII. The voice. 

VIII. The laryngeal region. 

IX. The trachea. 

X. The percussion of the thorax. 

XL The auscultation of the thorax. 

1. The Respiratory Movements. [Respirations]. 

The respirations should be examined in regard to fre- 
quency, m a n n e r in which produced, and any special 
sounds originating during the act of breathing. These 
three factors help to determine whether dyspnea be 
present or not. 

Frequency of respirations. To determine the number of res- 
piratory movements per minute each rise or fall of the flanks 
or ribs is counted. Observing the play of the nostrils is not as 
certain a method, as these organs can be voluntarily moved by 
the animal. In winter the breath can be seen appearing as steam 
at each expiration. The respirations should be counted for at 
least thirty seconds; in restless animals the veterinarian should 
stand quietly near, count several times and take the average ob- 
tained as the respiratory frequency. 

The smaller the animal the greater the number of respira- 
tions. In one and the same animal the number of respirations 
per minute will vary within physiological limits. 

Just after partaking of food, or when the abdomen is very 
full, and especially after exercise, an acceleration of respira- 
tions is a normal consequence. High atmospheric tempera- 
tures, restlessness and anxiety, also make the breathing more 
hurried. In adult animals standing at perfect rest the follow- 
ing number of respiratory movements per minute may be 
taken as the average normal : 

Horse 8-16 

Ox 10-30 

Sheep and goat 1 2-20 

Swine 1 0-20 

Dogs 10-30 

•Cats 80-30 

Fowls 10-50 



92 CLINICAL DIAGNOSTICS. 

A pathological increase in the number of respiratory 
movements is spoken of as dyspnea (see this). A decrease in 
the number of respiratory movements is rarely observed. It is 
seen in severe brain affections (hemorrhage, hydrocephalus, 
tumors, poisonings, action of septic substances during the 
course of pulmonary gangrene), also where the anterior air 
passages are occluded (stenosis), which is combined with a 
pronounced inspiratory tone. 

Physiology of respiration. When an animal is at 
perfect rest, the respirations are produced by the action of the 
diaphragm. The contraction of the diaphragm produces a dila- 
tation of the thorax. When the organ contracts it flattens and is 
■drawn backwardly, the false ribs becoming elevated. Notwith- 
standing that the diaphragm is stretched 
transversely between the thoracic and ab- 
dominal cavities, its contraction does not 
•cause its points of insertion to approach 
each other, for the reason that the intestines keep it con- 
tinually forward, which produces a drawing anteriorly of the ribs 
rather than to cause them to approach the median line. O n 
account of the double articulation of the 
ribs with the dorsal vertebrae the forward 
movement of them is accompanied by a rota- 
tion. The diaphragm dilates the thorax in that it draws the ribs 
forward and rotates them outward at the same time. 

The expiration follows the relaxation of the diaphragm, 
which takes place immediately after the inspiration. The dura- 
tion of expiration is longer than that of inspiration; between 
them in quietly breathing animals there is a short pause. 

The normal rhythm of the respirations can be pathologic- 
ally altered in that : 

1. The inspiratory movement lasts too long, 
the free entrance of air being prevented by stenosis of the 
respiratory passages. 

2. The expiratory act lasts too long, the relax- 
ation of the diaphragm not sufficing to a complete expiratory 
movement. 

As the respirations are in a measure controllable by the 
will, which depends upon the cerebrum, excitement or inflam- 
matory conditions occasioning either brain irritation or depres- 
sion, at times can bring about marked change in the rhythm 



QQ 

RESPIRATORY APPARATUS. 



of respiration. The value of these changes to diagnostics is 

limited. . . mar h-aA 

The intensity (depth) of the respirations .s not marked 
i„ healthy animals standing at rest. The alae of the nostril 
are hardly moved, and the ribs but slight y raised. The 
i n t e n s it y i s i n e r e a s e d by exere.se ; if it is augmented 
and the animal at rest, it denotes disease. Horses dilate the 
nostrils trumpet-like, dogs open the mouth (pant) ^pro- 
trude the tongue. The movements of the ribs and flanks are 
pronounced. The development of the intensity agrees with 

the Xin tenuis diminished when the pleura, 

nrUttfsitT-Telome asymmetrical 

in that one side of the thorax undergoes a deeper or more 
rapid movement than the other side. This is seen m painful 
unilateral pneumonias or pleuntes. 

When the rhythm and intensity of breathing is normal 
and the ribs and abdomen are moved with even regularity, the 
pi of the respirations is spoken of as »*"»*-£ 
If the respiratory movements are produced pr.nc.pall, b> he 
binary muscles of breathing, which dflate the thorax ,1 
tvoe becomes costal. The costal type is seen to occur where 
air can not pass freely into the thorax or where the diaphragm 
or adjacent organs are diseased, (abdominal tumors, ascites, 

'"^When'the abdominal muscles are more active in produc- 
ing the respiratory movement than the thoracic muscles the 
V of Treadling becomes M*L The abdomma 
tvoe prevails when painful conditions of the chest wall are 
preLuand where "expiration is difficult, as » pulmonary 

e nre a isso— s observed in animals a «-*-*£ 
corresponds to hiccoughs (singultus) m main It c ara 
terized by a rhythmic, spasmotic contraction of the diaphragm 



94 CLINICAL DIAGNOSTICS. 

(abdominal pulsation) with which a jerky movement of the 
thorax in the hypochondriac region occurs. Occasionally it 
is accompanied by a dull sound. Its rhythm is synchronous 
with neither the heart's beat nor the respirations. The latter, 
however, are temporarily arrested by the spasms. Singultus 
is usually temporary and probably due to a diaphragmatic 
neurosis. 

Respiratory Sounds. 

The respirations of healthy animals are performed noise- 
lessly. Only occasionally do they voluntarily emit audible 
sounds during the act of breathing. 

Physiological Sounds. When excited suddenly by 
perceiving peculiar looking objects, strange persons, unaccus- 
tomed odors, etc., horses and cattle snort by violently and 
noisily forcing air through the dilated nostrils. Horses of 
lively temperament usually snort when led at the end of the 
halter. Horses blow their noses by causing a forced expira- 
tion which is accompanied by a vacillating noise. As in man, 
dust or mucus is thus removed from the nasal organs. Fat, 
rough coated dogs pant when the weather is warm even when 
they are at rest. While performing hard work or during 
forced exercise the breathing is rapid and deep ; the air pass- 
ing in and out of the dilated nostrils at each in- and expiration 
produces a perceptible puffing sound. Spirited horses while 
being ridden at a gallop, emit a blowing expiratory sound 
every time the forefeet come in contact with the ground. 

A yawn is a long-drawn-out, deep inspiration taken with 
the mouth held wide open. The inspiratory muscles assist in 
producing it. 

Pathological Sounds. When the respiratory apparatus 
is diseased the following pathological sounds may 
occur : 

1. The wheezing or blowing sound which is stenotic in 
its character, emanates from the nasal cavities. It is more 



RESPIRATORY APPARATUS. 95 

pronounced at inspiration, and results from a narrowing of 
the nasal chambers due to the presence of tumors, swelling 
of the alae of the nostrils, septum or chonchae, enlargements 
of the turbinated bones or fractures of these bones, fractures 
of the nasal bones, or deposits of exudate on the mucous 
membrane. Depending upon the condition of the mucous 
membrane, the stenotic sound may be accompanied by either 
moist or dry rattling noises. 

2. Snoring takes place when the act of breathing is ef- 
fected through the open mouth, the soft palate undergoing a 
fluttering motion. In swine and dogs it occurs when the 
lumen or the nasal cavities is contracted by swelling or thick- 
ening of the mucous membrane. Snoring is also noted in the 
ox when the retro-pharyngeal lymph glands are swollen or 
enlarged ; further in the course of parturient paresis. Horses 
under chloroform sometimes snore. 

3. Rattling is a stenotic laryngeal sound which occurs 
when the vocal cords are relaxed. It is heard in severe in- 
flammations of the larynx or of the neighboring pharyngeal 
mucous membrane; phlegmon of the pharynx and edema of 
the glottis. 

4. "The Mucous Click" (klatsclicnder Xasalton) is a 
peculiar metallic, short expiratory sound first described by 
Dieckerhoff. It occurs during an inspiratory-expiratory dys- 
pnea if the nasal mucous membrane is very moist. At a 
forced inspiration that part of the nasal mucous membrane 
which unites with the skin of the false nostril, is sucked 
against the opposite wall to which it adheres for a moment ; 
when an expiration takes place this adhesion is broken, caus- 
ing a metallic "slapping" tone to be emitted. This sound is 
of no significance. 

5. The most important pathological re- 
spiratory tone is the stenotic laryngeal tone. Normally 
the sound emitted by the larynx is a soft stenotic sound audi- 
ble when the ear is placed over the organ. [It can be imitated 



96 CLINICAL DIAGNOSTICS. 

by pronouncing the German "ch"]. If the lumen of the lar- 
ynx is narrowed, the noise becomes loud. It is most fre- 
quently heard in the horse, and is one of the characteristic 
symptoms of roaring. 

Ordinarily the tone is emitted when the respirations are 
accelerated during exercise, but in cases where the lumen of 
the larynx is much diminished, it may appear when the patient 
is at rest. 

The character of the tone will vary from whistling to a 
pronounced hoarse or roaring sound. 

Besides it may be due to a firm swelling of the laryngeal 
mucous membrane (phlegmonous laryngitis, strangles), tu- 
mors in the larynx or its neighborhood which prevent the 
free entrance of air. 

6. Loud rattling noises [garglings] are heard when the 
larynx or the trachea contains loose masses of mucus. 

7. Sneezing is an explosive expiration through the nose, 
which originates reflexly from irritations to the nasal mucous 
membrane. It is heard in rhinitis (nasal catarrh) or when 
foreign bodies enter the nasal cavities. Sneezing only occurs 
in the dog, cat, and fowl. 

8. Groaning (moaning, grunting) is heard when a long 
inspiration is followed by a prolonged, ' audible expiration 
through a partially closed glottis. The sound is emitted only 
at expiration. Groaning is not necessarily a sign of disease, 
for it often occurs in healthy animals, especially cattle after 
a full feed or when pregnant. Groaning is produced by the 
pressure of the distended abdominal organs upon the dia- 
phragm, shortening the expiratory moment, which the animals 
seek to retard by partially closing the glottis. 

d. Labored Breathing, Dyspnea. 

The collective term dyspnea is applied 
to essential deviations from the normal in 
the frequency and kind of respiratory move- 



RESPIRATORY APPARATUS. 0? 

tnents, and the occurrence of accompany- 
ing pathological sounds. 

Physiologically a dyspnea occurs whenever the blood 
flowing through the respiratory center contains an abnormal 
amount of CO.,. Accordingly, anything which increases the 
quantity of CO., in the tissues, or interferes with the exchange 
of gases in the lungs, can cause a dyspnea. 

Clinically the presence of dyspnoea is recognized: 

I. If the respirations are accelerated (altered in 
number), and the increased frequency is not attended with 
■change in the method of breathing the dyspnea is simple. 

In the horse, for instance, the number of respirations can 
exceed 120 per minute and be superficial, only the nostrils 
becoming dilated. If, however, the respirations 
areverydifficult.itceasestobesimpledysp- 
n e a , for the method of breathing becomes more intensive 
and labored, and the dyspnea mixed. 

Simple dyspnea appears : 

1. In fever; the degree of respiratory frequency de- 
pends upon the severity and nature of the disease. 

2. In all conditions which make the respiratory act 
painful : diseases of the pleura, diaphragm, thoracic wall, 
peritoneum. 

3. Where the breathing surface of the lung is decreased 
•or where the organ is prevented from properly expanding: 
pneumonia, pulmonary tuberculosis, abdominal tympanitis, 
ascites. 

4. In diseases of the heart which have a congestion of 
the blood in the lungs as a consequence. 

II. If the respirations are labored ( a 1 1 e r e d i n q u a 1- 
i t y ) , though the frequency may be normal, aggravated dysp- 
nea. The occurrence of respiratory noises 
always indicates a difficulty in breathing. 
Depending upon whether the expiration or inspiration is dif- 
ficult, an expiratory or inspiratory dyspnea is distinguished. 



98 CLINICAL DIAGNOSTICS. 

The inspiratory dyspnea. If the entrance of 
air into the respiratory organs is made difficult, the animal 
seeks to overcome the condition by taking forced inspirations. 
Not only is the diaphragm actively employed, 
b u tot hermuscles which are nor mally not used 
during inspiration are called into play. 
These muscles are : the serratus magnus, serratus anticus, 
external intercostals, levatores, costarum, scalenus. The 
following clinical symptoms character- 
ize dyspnea: 

The nostrils are widely distended; dogs, fowls, cattle and 
swine breathe with their mouths open. Dogs sometimes close 
the jaws and breathe through the lateral commissures of the 
mouth, sucking in the cheek at each inspiration. The head 
and neck are extended horizontally, the larynx is retraced, the 
ribs greatly elevated and rolled forward. The forelimbs are 
spread far apart and the elbows turned out so that the serrati 
and pectoral muscles can better come into play. 

If, in aggravated inspiratory dyspnea, the air enters the 
lung very slowly, notwithstanding that the ribs are greatly 
elevated, and the thorax is distended to a' degree which does 
not correspond to the quantity of air passing in, a suction 
pressure will occur, which can be recognized by a sinking of 
the lower anterior thoracic wall — particularly of its inter- 
costal spaces. 

Inspiratory dyspnea is observed: 

1. In a pure form in bilateral paralysis (paraplegia) of 
the larynx and in severe cases of unilateral paralysis of the 
organ (hemiplegia, roaring). It is characterized by the above 
cited inspiratory dyspnea and the appearance of a stenotic 
laryngeal bruit. In less severe cases of roaring this symp- 
tom can only be brought out by exercising the patient. The 
act of expiration is performed without difficulty. 

2. In less pure form where a stenosis of the nasal pas- 



RESriRATORY APPARATUS. 9J) 

sages, pharynx, larynx or trachea exists due to inflammatory 
swellings, tumors, etc. In such cases a stenotic sound is 
emitted at each inspiration and the expiration is more or less 
difficult. 

3. In diseases of the bronchi and lungs preventing the 
free entrance of air : bronchitis, pulmonary edema, pneu- 
monia. 

4. Where the principal respiratory muscle, the dia- 
phragm, is inactive : rupture or inflammation, tympanitis. 

E x p i r a t o r y d y spnea, This occurs when the 
exit of the air from the lung is made difficult. In this case 
the expiration ensues not alone passively, but the accessory 
expiratory muscles actively assist. The 
muscles aiding expiration are: the abdominal muscles (exter- 
nal and internal oblique, straight abdominal muscle), the in- 
ternal intercostals and triangularis. An expiratory 
dyspnea is recognized by the following 
s y m p t o m s : The expiration is prolonged and is attended 
with pronounced movement of the abdominal wall (pumping 
of the flanks). At first, a limited sinking of the thoracic walls 
ensues from a relaxation of the diaphragm, then the abdominal 
muscles become active (contract) and a furrow is formed 
along the course of their insertion to the costal cartilages — 
the so-called "heave line." The passive and active moments 
of expiration can be plainly distinguished from each other, so 
that the movement of the flank appears to be a double primp- 
ing. The back is elevated at expiration and sinks during 
inspiration. At the moment of expiration the arms is greatly 
protruded. When the abdomen is well filled, these symp- 
toms appear more prominently. 

Expiratory dyspnea occurs : 

1. In vesicular and interstitial emphysema. 

2. In chronic bronchitis and peri-bronchitis. 

3. Where the lung has adhered to the costal wall. 

A m i x e d d v s p n c a is present when accelerated 



100 CLINICAL DIAGNOSTICS. 

respiratory frequency is combined with difficult inspiration 
and expiration (inspiratory and expiratory dyspnea). It is 
the most common form of dyspnea and attends all severe 
diseases of the respiratory tract (pneumothorax, hydrothorax) 
and also those diseases which have no primary seat but whose 
course is accompanied by a severe intoxication of the blood 
with C0 2 — as in many of the infectious diseases. 

In pronounced mixed dyspnea there is a marked flap- 
ping of the nostrils. At the beginning of inspiration both 
wings (medial and lateral) are greatly distended. At the 
end of the inspiratory movement they again collapse. How- 
ever, the forced out-flow of air at expiration, which imme- 
diately follows, forces the medial wing, which is in its path, 
outward and upward causing a second movement of this 
wing to occur. 

According to the seat of the respiratory obstruction one 
speaks of a nasal, laryngeal, tracheal and pulmonary dysp- 
nea. , 
II. The Breath. 

An examination of the air breathed out by the lungs is 
of diagnostic importance in many morbid conditions. Nor- 
mally the air is emitted from the nostrils in two odorless cur- 
rents of equal size. The two deviations from the normal are : 

1. The air currents from both nostrils are not of equal 
sice. Where one of the currents is smaller (of less volume) 
than the other, it points to a narrowing of the nasal 
passage of that side. Not infrequently a blozving sound 
accompanies the inspiration. The passages may be con- 
stricted by thickenings or swellings of the mucous membrane 
or by tumors. 

2. The breath has a bad odor. A bad odor from the 
nostrils is always a sign that putrid decomposition is taking 
place in the air passages. It may emanate from various parts 
of the respiratory tract. The odor is either putrid (fetid) 
or carious. It is observed: 



RESPIRATORY APPARATUS. 101 

1. Where stagnant masses of putrefying exudate are in 
the turbinated bones, sinuses, gutteral pouches, or even on the 
mucous membrane of the upper air passages and bronchi. 

2. In putrid decomposition of tumors in the air passages. 

3. In suppuration or necrosis of the bones of the head 
bordering on the air passages: Suppuration in the tooth 
alveoli, dental caries, necrosis of the turbinated bones. 

4. In gangrene of the lungs. 

It is always important to determine where the odor 
originates. At first we should be clear as to whether it 
really comes from the nose or from the mouth. When the 
mouth is closed, this is usually not difficult ; in doubtful cases 
the odor of the saliva can be tested. The safest way is to 
make an examination of the buccal cavity, especially of the 
teeth. When the alveoli of the upper molars are diseased, a 
carious smell is emitted from both the mouth and nose. (See 
Examination of the Mouth). 

If the offensive odor has been found to come from the 
expired air, it is then necessary to locate the part of the 
respiratory apparatus at which the decomposition is taking 
place. For this purpose we should first determine whether or 
not the odor is equally offensive from both nostrils. When 
the odor from one nostril is more prevalent than from the 
other, the process of decomposition has its seat in the nasal 
cavity of that side, and usually it is accompanied by a unilat- 
eral nasal discharge, bulging of the facial bones and swelling 
of the submaxillary lymph glands. 

The examination of the upper molar teeth of that side 
should never be neglected. 

When the odor is equally offensive from either nostril, 
the putrid focus is as a rule contained in the lung, more rarely 
in the pharynx, larynx or trachea. 

Putrid decomposition in the lung is not 
always to be ascribed to pulmonary gan- 
grene, for not infrequently adecomposi- 



102 CLINICAL DIAGNOSTICS. 

tion of exudate in the bronchi, (fetid bronchitis) 
is present. 

The presence of elastic fibres in the nasal discharge 
speaks for pulmonary gangrene. 

III. Nasal Discharge. 

Only in the ox a slight nasal discharge is seen to occur 
in health, which the animal usually removes from the nostrils 
with its tongue. In the other animals the appearance of a 
nasal discharge is always a sign of disease, and one of con- 
siderable diagnostic importance. It can accompany all dis- 
eases of the respiratory tract which are exudative in char- 
acter, such as catarrhs of the nasal cavities, sinuses of the 
head, throat, larynx, trachea, bronchi and lungs. In these 
cases the discharge is the product of the disease. Some- 
times the discharge comes from the digestive tract, from the 
mouth or pharynx, more rarely from the gullet or stomach, 
when it contains substances such as food particles, water or 
saliva. 

The character of the nasal discharge depends upon the 
organ from which it comes and the nature of the disease pro- 
ducing it. We should bear in mind that the ox, sheep, goat 
and dog usually lick off the discharge, hence it is not so 
noticeable in these animals as in the horse. 

To correctly judge nasal discharge the following should 
be considered : 

a. The quantity, which will vary greatly. The dis- 
charge is slight in catarrhs that are neither very diffuse nor 
severe. In tuberculosis, notwithstanding the severity of the 
case, there is little discharge because what little exudate 
appears upon the surface of the mucous membranes is re- 
moved by coughing and eventually swallowed. 

The discharge is copious in strangles and in diffuse 
catarrhs of the upper air passages and bronchi. 

Unilateral nasal discharge is characteristic of disease of 
one side of the anterior air passages as far back as the fauces. 



RESPIRATORY APPARATUS. 103 

A catarrh involving but one side of the soft palate or pharynx 
may also show a discharge from only one nostril. 

Of especial importance is the variation in quantity of the 
discharge. In some cases a copious amount of discharge is 
ejected when the head is suddenly lowered [unreining after a 
drive], while for a day or more there is present either no dis- 
charge at all or only a very slight one. This symptom is 
characteristic of catarrhs of the frontal and superiormaxM- 
lary sinuses and of the guttural pouches. 

b. The color. The color of the nasal discharge de- 
pends upon the character of the inflammation, and also the 
presence of foreign mixtures. It will vary from colorless to 
grey, white, yellozv, red, brozvn or green in all their different 
tints. During the course of a disease the color of the nasal 
discharge will change with the character of the inflamma- 
tion. A serous or mucous discharge is usually colorless ; a 
purulent discharge is grey or yellow or may be of a greenish 
hue. 

A green discharge is usually due to an admixture of the 
chlorophyll of the food, deglutition being difficult. Food 
particles are always present in such cases. In rare instances 
a greenish tinge is seen, due to decomposed blood coloring 
matter being present in the discharge. 

A yellozv, rust-colored ["prune juice"] discharge is seen 
in hemorrhagic hepatization of the lungs (contagious pleuro- 
pneumonia of the horse). It is due to an admixture of blood 
coloring matter. 

In rare instances a rusty brown nasal discharge is pres- 
ent in severe catarrhal affections of the anterior respiratory 
passages (strangles, pharyngitis). 

A bloody discharge (cpistaxis) is observed only when 
blood in toto is present. It may be due to : 

1. Finger-nail injuries to the mucous membrane of the 
nose or fractures of nasal bones. In the dog the presence 
of pentastomum tenioides may lead to bloody nasal discharge, 
and in sheep the larvae of oestrus ovis. 



104 CLINTCAL DIAGNOSTICS. 

2. Ulcers ; glanders ; bleeding tumors in the nasal cavi- 
ties. 

3. Nasal hemorrhages may attend anthrax in the ox r 
purpura hemorrhagica, or very severe cases of contagious 
pleuropneumonia of the horse. 

The discharge may consist entirely of blood, or simply 
of an admixture of blood. If the hemorrhage is from a 
nasal cavity, it is unilateral, the blood appears fresh and in- 
completely mixes with any other discharge present. If from 
the lungs, it is more or less foamy and in the trachea one 
may hear moist rales. 

c. The consistency of the nasal discharge depends 
upon what it contains. It may be serous, mucous or mucil- 
aginous, with varied intermediations. It may also be floccu- 
Icnt, clumpy, or contain great masses of adhering exudate. 
In the beginning of a catarrh the discharge is serous (clear), 
but by admixtures of mucus it becomes mucous and loses its 
transparency from the quantity of epithelial cells it contains. 
Its color is then grey. When an admixture of pus is present 
the discharge assumes more of a cream-like consistency and 
its color changes to greyish-yellow or yellow. A discharge of 
pure pus only occurs when an abscess ruptures into the nasal 
cavity. 

A clumpy, buttermilk-like discharge is 
observed in chronic catarrh of the sinuses of the head because 
the exudate has been retained for a time. 

Adhering masses of exudate are seen in diph- 
theritic, croupous, or fibrinous inflammations. 

d. The odor. The odor of the nasal discharge be- 
comes foul, putrid or carious from decomposing processes. 
In such cases the breath is also tainted. For the determin- 
ation of the seat of the disorder, what has been said concern- 
ing the odor of the expired air applies. 

e. Foreign admixtures. Most commonly we observe 
air bubbles of large or small size which cause the discharge 

to appear as foam. 



RESPIRATORY APPARATUS. 105 

Fine foam. When the discharge comes from the smaller 
bronchi in pulmonary edema and bronchitis, the foam is 
composed of small air bubbles of equal size. When there is 
much foam the discharge is white in color. Horses suffering 
from chronic bronchial catarrh after exercise show a white 
nasal discharge partially made up of fine foam. 




Fig. 28. Egg- of Pentastomum Tenioides. 

Coarse foam. This is not infrequently unilateral and 
contains an admixture of food particles. . It comes from the 
mouth and consists in part of saliva. The air bubbles are 
of unequal size. Coarse foam is symptomatic of paralysis 
of the pharynx, pharyngitis (fungus poisoning). 

When food particles alone make up the nasal dis- 
charge, it is a sign that vomiting has taken place. The dis- 
charge is then not foamy, is of acid reaction and contains no 
admixtures of exudate. 

A microscopical examination of the nasal 
discharge is rarely of practical value. It may sometimes be 
of use to determine the presence of the embryo or egg of 
Strongylus filaria in the lungs of sheep or of Pentastomum 
taenioides in the nasal passages of the dog, or in fetid nasal 
discharge, the elastic fibres. 

The examination for pathogenic micro- 
organisms yields positive results only in exceptional cases. 
The tubercle bacilli are one of these exceptions as their char- 
acteristic way of accepting stains serves to identify them 
microscopically. 

Microscopical determination of tubercle bacilli. A cover-glass 
preparation is covered with Ziehl's carbolized-fuchsin solution 



106 



CLINICAL DIAGNOSTICS. 



(fuchsin 1, absolute alcohol 10, carbolic acid 5, aq. dist. 95), and 
heated repeatedly for about two minutes over a flame. Wash 
and drain. Gabbet's solution (methylen blue 2, in 100 grammes of 
a 25% sulphuric acid) is then applied and allowed to remain J/£ 
minute. Wash and examine. 

Fig. 29. 




Tubercle bacilli. 



Besides the tubercle bacillus, other bacilli (acid-fast), which 
stain by this method, are found in the feces of cattle and in butter. 



IV. The Nasal Cavities and Adjacent Sinuses. 

The external appearance of the facial bones will readily 
betray any deformity. Circumscribed enlargements are 
due to tumors and a bulging of the sinuses in chronic catarrhs. 
Diffuse enlargements attend rachitis and osteoporosis, "big 
head." Depressions have a traumatic origin. Swellings 
appearing at the nasal openings and nostrils are common in 
purpura hemorrhagica. Tumors (atheromas) are frequent 
in the false nostril. 

The specific pathological conditions 
which occur about the lips and nose are the pustules and 
ulcers which attend contagious stomatitis, the pox pustules of 
sheep pox, and the vesicles on the muzzle of the ox and snout 
of swine suffering from foot and mouth disease. 

When a nasal discharge has existed for a long time, the 
integument of the nose and lips over which it flows loses its 



RESPIRATOR V APPARATUS. 



107 



pigment. The white streaks thus formed speak for the 
chronicity of the discharge. 

The examination of the nasal mucous membrane.' The 
nasal mucous membrane is available to inspection only in 
the horse. Local lesions occurring on it are often of great 
diagnostic importance. 

Method of examination. The head of the animal should he 
elevated and the inner cartilaginous wing of the nostril grasped 
between the thumb and middle linger which draws it upward and 
outward; the extended index finger is then inserted under the 
outer wing, which it distends. The patient should face the light, 
•xcept when the rhinoscope (an enlarged ophthalmoscope) is used. 

Fig. 30. 




Examination of the Mucous Membrane. 

a. Discolctations. Indistinct, punctiform, or ramiform 
redness is not infrequently seen in acute and chronic catarrhs ; 
they are due to the peculiar anastomosing of the capillaries 
and are of no diagnostic value. 

Deep redness is mostly the result of hemorrhages in the 
mucous membrane. They appear mostly punctiform and can 
be as large as a ten-cent piece, they arc well circumscribed 
and of round form (peteehiae, ccchymoscs). When they 



108 CLINICAL DIAGNOSTICS. 

become confluent, the redness is diffuse or appears in irregular 
streaks. Petechiae are most commonly seen in purpura 
hemorrhagica, but may also occur in severe anemia 
(rare) and in leucemia. The spots, which are at first dark 
red, soon fade and assume a brownish hue. Such suffusions 
are also observed in septicemic diseases : anthrax, septicemia. 

b. Swelling of t he - nasal mucous mem- 
brane is characterized by the normal surface of the mucous 
membrane, which is granular from the many glands it con- 
tains, becoming firm and smooth. • As the membrane is 
usually tense, the swelling is not marked. Its origin is in- 
flammation, therefore the surface appears turbid. 

Chronic, connective tissue thickenings 
are most commonly made manifest by irregular, wart-like 
prominences which show the characteristics of scars. 

c. Wounds inthe mucousmembrane are usu- 
ally at the lowest part of the septum, and are very often 
caused by finger-nails, sharp straws and the like. 

d. Nodules from the size of a millet seed to that of a 
peppercorn almost exclusively attend glan- 
ders. Exceptionally they result from contagious stomatitis, 
but in such cases like nodules are to be found in the mucous 
membrane of the mouth. To prevent mistaking particles of 
mucus for true nodules, the supposed nodule should be pal- 
pated with the finger ; if mucus particles, we can thus wipe 
them off. 

e. Ulcers. Nextto nodules, ulcers form 
the most important criterium in diag- 
nosing glanders. Glanders ulcers have jagged bor- 
ders circumscribed by rounded, elevated walls. The base of 
the ulcer is sunken, uneven, grey in color, and of lardaceous 
appearance. The favorite seat of the glanders ulcer is on the 
medial border of the inner cartilaginous wing of the nostril, 
hence "this place should always be examined. 

In rare cases ulceration of the nasal mucous membrane 



RESPIRATORY APPARATUS. 



109 



also attends stomatitis and purpura hemorrhagica. For dif- 
ferentiation the concomitant symptoms must be considered, 
such as ulcers on the buccal mucous membrane, petechiae, etc. 
Very superficial p i 1 1 i n g s with sharp 
b o r d e r's — not rounded nor red colored — represent the 
catarrhal or erosion ulcer. 

f. Cicatrices at the lower end. of the nasal septum 
are mostly the result of previous wounds. They are often 
curved ( ( as if made with a finger-nail. Glanders cicatrices 
are as a rule more or less star-shaped. 

The examination of the sinuses of the head is often 
of importance and should be made whenever a chronic nasal 
discharge exists, especially when attended with an unilateral 
bulging (enlargement) of the facial bones. Mere enlarge- 
ments can be defined by palpation. The presence of exu- 
dates in the sinuses can sometimes be determined by percus- 
sion. The normal percussion sound of the sinuses is full, but 
when they are filled with exudate or tumor masses, it becomes 
flat. When the sinuses are only partially- 
filled the percussion sound is not changed. 
Negative results from percussion, therefore, do not exclude 
the presence of exudate. 

[A simple method of exploring the sinuses of the head, 
to determine whether exudate (pus) is present in them or not, 
is to bore a small hole into them with a "Yankee" drill. If the 
sinuses contain pus or other exudate, the bit becomes soiled 
by it and if the contents are fetid, will smell.] 

V. The Submaxillary Lymph Glands. 

Although these glands do not properly belong to the 
respiratory apparatus, the examination of them is significant 
in the horse. In this animal especially, the glands become 
sympathetically diseased when pathological conditions exist 
within the domain of their lymph vessels. 



110 CLINICAL DIAGNOSTICS. 

Anatomy. The lymph vessels from the nostrils to the ethmoid 
bone carry their lymph to the submaxillary glands, a small glan- 
dular packet as broad as and a little longer than a finger, lying 
on each side of the intermaxillary space. They begin at the point 
where the inferior maxillary artery passes under the ramus of the 
lower jaw, and extend forward to the angle of the chin where 
each unites with its fellow of the opposite side. Each lobule is 
of about the size of a small bean. In horses of coarse conforma- 
tion the intermaxillary space is often filled without the glands 
being swollen. 

As soon as an absorption of irritant or 
infectious substances [bacteria] takes 
place in the region drained by the lymph 
vessels of the submaxillary glands, these 
organs become secondarily diseased. The 
primary disease usually has its seat in the mucous membrane 
of the nasal passages or sinuses. An examination of the 
glands, therefore, is of great significance in determining the 
pathological condition of these mucous membranes. 

In making the examination the following points are to be 
considered : 

a. Is one o r both glands enlarged? In acute 
infectious catarrhs the glandular swelling is generally bilat- 
eral; in glanders frequently unilateral, and in tumors in the 
nasal passages, bad teeth and chronic catarrh of the sinuses, it 
is, as a rule, unilateral. 

b. Size and form of the glandular swell- 
ing. Many or a few of the lobules may be enlarged to the 
size of a bean, pigeon or hen's egg, depending upon the pri- 
mary disease in the mucous membranes. Acute swellings are 
smooth; chronic swellings lobulated (nodular), which is espe- 
cially marked in glanders. 

Well marked, clearly defined, smooth enlargements of 
individual lobules are observed in leucemia (a hyperplasia), 
and when malignant tumors are developing in the glands. 

c. Consistency of the swollen glands. The 
swelling is soft in serous, tense and firm in cellular infiltration 
of the glands. Acute diffuse swellings (s t r a n - 



RESPIRATORY APPARATUS. Ill 

g 1 e s ) often lead to suppuration (ab- 
scess) , which can be determined by fluctuation. In 
glanders diffuse abscess formation never occurs in the glands ; 
only rarely does a small purulent focus (farcy bud) appear in 
the skin over the gland. Firm, hard enlargements 
are always due to some chronic irritation and consist of con- 
nective tissue proliferations. Such attend chronic glanders, 
catarrhs and dental fistulae. 

(1. Temperature and sensitiveness. When 
the glands are hot and tender (inflamed), the morbid con- 
dition is acute (strangles). If the enlargement of the gland 
is firm, cold and painless, it points to glanders, chronic catarrh, 
tumors or hyperplasias [leucemia]. 

Movability of the glands. If the irritatiou 
is -chronic and attended with the formation of new connective 
tissue, the process involves the environing tissue, forming ad- 
hesions with its neighborhood. In acute purulent inflammation 
of the glands there develops in the vicinity, namely, directly 
beneath the skin, an inflammatory edematous and later a 
phlegmonous swelling. 

The extirpation of a diseased lymph gland is recommended 
where glanders is suspected. Its object is the patho-anatomical 
or bacteriological examination of the gland. The operation can 
be performed on the standing animal when local anesthesia is 
employed, and is not dangerous. 

VI. Cough. 

Cough is a suddenly occurring expi- 
ratory impulse which follows a deep in- 
spiration. The glottis is forcibly opened 
during the act, causing a sound to be 
emitted. By coughing accumulations of mucus are re- 
moved from the bronchi, trachea or larynx. Tn animals cough 
is a reflex action which can to a certain extent be suppressed. 
Although it can be induced by irritation to many peripheral 
nerves, as a rule it emanates from branches of the vagus nerve 



112 CLINICAL DIAGNOSTICS. 

in the respiratory apparatus. Most sensitive in this particular 
is the superior laryngeal nerve, which is the sensory nerve of 
the larynx, and the first three rings of the trachea. The mucous 
membrane of the trachea is less sensitive, except at the bifur- 
cation of the bronchi. The bronchi are just as easily irritated 
as the larynx ; but cough can not be excited from 
the parenchyma of the lungs. It can, however, 
arise from the pleura when this organ is in a state of irritation. 
Peripheral irritation is transmitted to the cough-center in the 
brain, which innervates the expiratory muscles and recurrent 
nerve, inducing the reflex spasm called cough. 

In exceptional cases cough can emanate from ter- 
minals of the vagus nerve lying outside of the respiratory appara- 
tus, as, for instance, from the external auditory meatus [ear], 
nose, or abdominal organs. According to Albrecht cough can 
occur from abscess in the liver. These are, however, exceptional 
cases. Cough from the stomach has never been ob- 
served in the horse. There is a possibility that cough may have 
its origin in the brain. These exceptions are worthy of note and 
should be considered in those cases of cough the cause of which 
cannot be found to lie in the respiratory apparatus. 

Cough occurs: 

1. If foreign bodies are inhaled: smoke, dust (dusty 
food), acrid gases (ammonia, sulphurous acid, chlorine, etc.). 

2. If cold air is inhaled, especially if the respiratory- 
tract is inflamed: catarrhs of the trachea and bronchi, pleuritis, 
traumatic injuries to the pleura (traumatic gastro-diaphragm - 
itis of the ox). 

3. If mucus, exudate or foreign bodies (food) and para- 
sites are present in the air passages: Gastrus larvae in the 
larynx, Syngamus trachealis in the wind pipe, Strongyli in the 
bronchi. 

In no case can cough originate when the sensory ter- 
minals of the vagus nerve are no longer 
susceptible to irritation. In severe phlegmonous 
diseases of the mucous membrane, cough is absent. The cough 
center in the brain must also be in normal condition. It is 
disturbed when great mental depression 



RESPIRATORY APPARATUS. 113 

•exists. Therefore, when appreciable irritations (rales) are 
present, unaccompanied by cough, the prognosis is an unfavor- 
able one. 

The character of the cough. The character of the 
■cough varies with the species of animal. Healthy horses have 
a strong, vigorous, loud, full-toned cough; cattle a sharper 
defined, softer, toneless, prolonged cough, the glottis being 
held open. The appearance of cough in animals is always ab- 
normal ; its character depends upon the disease which causes 
it. Whether cough accompanies the disease or not can usually 
be learned from the anamnesis, although we can not depend 
upon this to determine its character. It is always best that we 
induce the patient to cough in our presence ; this may be done 
by pincEIng the upper three rings of the trachea or pressing 
the finger ends of both hands against the arytenoid cartilages 
of the larynx. In sensitive healthy horses one or a few short 
coughs will follow the manipulation, while in indolent indi- 
viduals there is no reaction. In the ox coughing can be in- 
duced in this way only when the animal is diseased. 

If the ox can be made to cough by pinching the upper 
trachea or larynx, or if coughing takes place in the horse 
when only slight pressure has been used, some abnormal irri- 
tation exists. If cough can be readily induced by pressing 
the lower windpipe, a tracheitis is present. 

The frequency of the cough. A cough may 
be occasional or frequent, continual or transitory. If the 
cough is occasional usually only one or a few impulses occur, 
but when frequent several in succession — a fit of coughing. 

The pain fulness of the cough is recognized by the 
general behavior of the patient which seeks to suppress the 
pain by shaking the head and making masticatory and swal- 
lowing movements. The animal may also be restless, paw 
and groan. A painful, painless, burdensome, and torturing 
cough may be distinguished. The cough is painful in acute 



114 CLINICAL DIAGNOSTICS. 

bronchitis, pleurisy, pleurodynia, and in so-called "whooping" 
cough" of dogs ; painless in chronic laryngitis. 

The force of the cough impulse depends upon 
the vigor of the action of the expiratory muscles and the elas- 
ticity of the lungs. Accordingly, the cough may be strong, 
vigorous, or weak. It is weak if expiration is difficult or if 
the patient is unable to cough vigorously : reduced, debilitated 
animals, pulmonary emphysema, bronchitis, hydrothorax ; or 
if the expiration is painful : pleurisy, pneumonia, pleurodynia. 
The cough is strong if the elasticity of the lungs is normal 
and no pain attends the act. 

The d u ration of the cough impulse is 
determined by the force with which the pulmonary air is held 
repressed by. the closed glottis. If the pressure is great, the 
glottis will be suddenly forced open and the cough will be 
short. If the glottis is not completely closed (paralysis of the 
arytenoid cartilage — roaring) or the repression of the air 
causes pain (pleurisy), the cough is long — prolonged. 

The depth and magnitude of the cough 
depend^ partly upon the force and duration of the cough im- 
pulse. The magnitude is influenced by the quantity of 'ex- 
pelled air. We speak of a deep and a shallow cough. 

The cough so u n d is dependent upon the force of 
the cough impulse, the tension of the vocal cords and the spe- 
cial condition of the surface of the mucous membrane. The 
sound may be loud, low, clear, dull, sharp, ivhistling, dense, 
hollozv, loose, moist, dry. 

The ''return impulse'' of the cough ( Hus- 
tenruecktstoss). Each cough is followed by a short, deep in- 
spiration. If the glottis is not fully open at the moment this 
inspiration takes place, the air rushing in causes the partially 
stretched vocal cords to vibrate, causing a harsh, short, laryn- 
geal stenotic sound to be emitted. It is heard in paralysis of 
the larynx (paraplegia, hemiplegia) and in severe inflamma- 
tory swelling. 



RESPIRATORY APPARATUS. 115 

Expectoration. The act of coughing tends to eject 
•masses of mucus, exudate, etc., from the bronchi, trachea, and 
larynx. Animals do not expectorate because that which 
is coughed up into the throat, as soon as it reaches the phar- 
ynx, is swallowed. Sometimes, however, a part is discharged 
through the mouth, the lower naso-pharyngeal wall and the 
soft palate being forced forward by the air passing out, which 
leaves the opening into the buccal cavity free. The thus ex- 
pectorated mass is usually mixed with mucus from the phar- 
ynx and mouth and also with food particles. 

It is possible to collect "sputum" from horses and cattle 
for microscopic or bacteriological purposes. The method of 
obtaining it is to cause the animal to cough, then place a spec- 
ulum in the mouth and reaching back with your hand as far 
as the larynx, gather the accumulated mucus in this region. 

Several times in horses suffering from tuberculosis I 
have thus succeeded in obtaining bronchial discharge in which 
tubercle bacilli were found. 

VII. The Voice. 

Cattle suffering from nymphomania keep up an almost 
continuous bellowing ; in advanced cases they moan loudly 
and constantly. At the approach of death horses sometimes 
utter a shrill neigh. 

Change in voice is of little significance in animals. 
Commonly we observe a hoarse voice in laryngeal catarrhs. 
This is most marked in dogs. In rabies the voice suffers 
change. In dogs affected with this disease the bark is pro- 
longed into a long, dismal howl, the voice being at the same 
time hoarse. In horses a short, squealing tone is emitted. 

VIII. The Larynx and Trachea. 

Inspection. Enlargements in the region of the larynx 
are as a rule not confined to this organ, but to neighboring 
tissues as the pharynx, lymph glands, subcutis. 



116 CLINICAL DIAGNOSTICS. 

Ill birds the larynx may be inspected by simply opening" 
the bill and pressing the larynx upwardly. In dogs and cats, 
and to a more limited extent in goats and sheep a view of the 
larynx may be obtained by opening the mouth and drawing the 
tongue forward. 

Laryngoscopy. 

With the aid of the laryngoscope invented by Polansky 
and Schindelka, the interior of the larynx may be examined 
directly. For the diagnosis of inflammatory conditions in the 
larynx this examination is of no practical value. However,, 




Fig. 31. 
View of the larynx with paralysis of the left side, as seen through the laryngoscope. 

in paralysis of the arytenoid cartilages the instrument can be 
used to advantage. [This instrument, which is a modified 
endoscope, consists of a cylinder 56cm long and -1.7cm in diam- 
eter, at one end of which is an optical illuminating apparatus. 
The light is furnished by an electric battery, and undue heat 
is prevented by a special cooling arrangement. The instrument 
is inserted through the nostrils and can be used in the horse 
without casting.] In left-sided paralysis of the larynx (roar- 
ing) the left arytenoid cartilage is seen to project farther into 
the lumen of the organ than the right one. This can be more 
distinctly seen when the larynx is moving. As the larynx o£ 



RESPIRATORY APPARATUS. 117 

the horse is usually held in the position of "middle inspiration," 
it is necessary to induce forced inspiration and expiration. To 
do this the thorax is encircled with a girth which is slowly 
and gently drawn tight and relaxed, alternately, imitating 
forced breathing. The larynx in the meantime is watched 
through the instrument. At each inspiration the healthy car- 
tilage is seen to move outwardly, while at each expiration it 
approaches the middle line. The diseased cartilage, on the 
other hand, either remains completely at rest (paralysis) or its 
movements are very tardily performed (paresis). 

In bilateral paralysis (paraplegia) of the larynx the 
patient may show dyspnea when at rest — at any rate, slight 
excitement will induce it. In such cases one will note that 
both arytenoids protrude into the lumen of the larynx at inspi- 
ration ; at expiration they are suddenly forced laterally and set 
in vibration. The paralysis can be complete or incomplete; 
it may not be developed to the same degree on both sides. 

Palpation. When we determine the seat of the en- 
largements by palpation we may at the same time note 
their temperature, sensitiveness, and the ease with which 
cough can be induced by pressing upon them. Where much 
exudation is found in the larynx, infiltration of the vocal cords 
or other folds of mucous membrane, a trembling of the organ 
may be felt (laryngeal fremitus). 

In examining the trachea we should look out for scars 
resulting from tracheotomy wounds. The 
form of the trachea should also be noted. In chronic trachei- 
tis of the ox the trachea may be shaped like a saber scabbard. 

Flattening of the trachea in horses is probably due to a 
paralysis of the transverse muscle. 

On auscultation of the larynx or trachea, nor- 
mally a stenotic sound is heard [like a German "ch"]. It is 
due to a vibration of the vocal cords and laryngeal walls which 
is produced by the air forced through the organ. It is heard 
best at expiration. When the mucous membrane of the lar- 
ynx is swollen and firm, this sound becomes very pronounced 



118 



CLINICAL DIAGNOSTICS. 



and assumes a whistling or hissing character. If the swelling 
of the laryngeal mucous membrane is loose, or deposits of exu- 
date cover the membrane, the sound produced is rattling or 
purring. 

IX. Percussion of the Thorax. 

To properly percuss the lungs a knowledge of their topo- 
graphical position is essential. 

Anatomy. The lungs and heart do not occupy the whole of 
the thoracic space. The abdominal viscera encroach upon a 
greater part of it. The partition between the chest and abdominal 
organs is the diaphragm. This organ is inserted, in the arc of a 
circle, to the inner surface of the whole thorax, reaching in an 




Fig. 32. 

Dorsal and ventral boundaries of the field of pulmonary percussion. — - — Costal 

attachment of diaphragm. H. heart, d. c. dorsal colon. 1. v. c. left ventral colon. 

oblique direction from the sternum backwardly and upwardly to 
the lumbar vertebrae. In the region of the sternum its points of 
attachment are at the union of the ribs to their cartilages, farther 
posteriorly, however, the diaphragm does not extend down as 
far as th? cartilages of the false ribs, but passes obliquely across 
their inner surfaces until, finally, at the last rib, it finds attach- 
ment at the superior end. The diaphragm arches forward from 



RESPIRATORY APPARATUS. 



119 



its points of insertion, extending into the thoracic cavity in the 
shape of a cone the apex of which reaches in the various ani- 
mals, somewhat beyond the middle of the 7th or 8th rib. At 
expiration the diaphragm lies with its muscular portion directly 
against the lateral chest wall, the tendinous portion then forming 
the partition. With the beginning contraction of the diaphragm 
at inspiration the arch becomes flattened in that the organ is 
drawn away from the inner wall of the chest. The space left 
by the receding diaphragm is immediately occupied by the sharp 
borders of the lungs which then lie close to the points of insertion 
of the diaphragm. At the acme of inspiration the rounded, cone- 
like form of the diaphragm becomes more pointed and its base 
and apex approach each other, the ribs having been drawn for- 
ward By this drawing forward of the ribs the transverse diam- 
eter of the thorax is increased and the base of the cone-like dia- 
phragm broadened. (See page 92.) 




Fig. 38. 

Dorsal and Ventral boundaries of field of pulmonary percussion. - -- Costal 

attachment of diaphragm. - - - - Curvature of diaphragm in median plane. 
- - - - Anterior boundaries of stomach divisions. H. Heart. V. fauncn. 

Accordingly, the lateral border of the lung is continually 
moving backward and forward, traveling a distance in the larger 
animals of 1-2 hands breadth, and in the smaller ones from y 2 to 1 
hands breadth. On an average the posterior border of the lung 



120 



CLINICAL DIAGNOSTICS. 



may be defined by a line which in the larger animals is the width 
of a hand from the points of insertion of the diaphragm. In 
small animals the distance is one-half this. 

The availableness of the lungs for clinical examination. 

Dorsally the area of percussion is defined by the thick muscles 
of the back. This boundary to percussion, which varies with 
the condition of the animal, is limited by a line drawn from the 
posterior angle of the scapula to the external angle of the ilium. 
Anteriorly the boundary is formed by the scapula and the 
massive shoulder muscles. 




Fig. 34. 
Heart, shaded portion not covered by lung. — Field of pulmonary percussion. 
— - — Insertion of diapragm. L. Liver. M. Spleen. N. Kidneys. 
R. Rectum. D. Small intestines. 



By drawing the leg forward the field of percussion can be 
somewhat enlarged. Ventrally the density of the sternum and 
muscles overlying it render in this region the lungs unavail- 
able to percussion. 

The field of percussion is a right-angled tri- 
angle the right angle of which lies at the 
base of the scapula. In all animals the dorsal and 
anterior boundaries of the field of percussion are the same, the 
only variation being in the abdominal boundary. 



RESPIRATORY APPARATUS. 121 

Horse. The abdominal boundary is a line drawn from 
the 16th intercostal space, crossing the middle of the thorax at 
the 11th rib, to the olecranon. 

T'he vortex of the diaphragm lies slightly above the 
of the thorax at the 8th intercostal space. 

Ox. In ruminants the field of percussion is small on ac- 
count of the less number of ribs (13), which causes the dia- 
phragm to lie farther forward. 

The abdominal boundary in this animal is a line drawn 
from the 11th intercostal space, crossing the middle of the 
thorax at the 9th rib, to the olecranon. 

Dog. In the dog the shoulder lies well forward, which 
gives a larger field of percussion. The abdominal boundary of 
the field extends to the 9th rib at the middle of the chest wall. 

Swine. In swine, percussion can rarely be employed, 
as the thick layer of subcutaneous fat and the restlessness of 
the animal greatly interfere. The abdominal boundary of the 
field of percussion extends from the 11th rib to the olecranon. 

The normal pulmonary percussion sound is due to the 
vibration of the thoracic wall, the elastic pulmonary tissue and 
to the air contained in the lungs. 

The intensity of the sound depends upon the 
volume of the air-containing lung tissue which is set in vibra- 
tion. It will vary with the force used in percussing, the 
thickness of the chest wall and the volume of the part of the 
lung vibrating. Accordingly, more force is employed in per- 
cussing a thick-walled chest than a thin-walled one. 

As the normal percussion sound at the 
boundaries of the field of percussion 
merges gradually into a tympanitic or a dull 
sound, the exact borders of the lungs can 
not be definitely defined under the ham- 
mer. 



122 CLINICAL DIAGNOSTICS. 

In vesicular pulmonary emphysema, interstitial emphy- 
sema (which is rare), and pneumothorax the field of per- 
cussion is somewhat enlarged posteriorly, the diaphragm suf- 
fering permanent backward displacement. 

An abnormally loud, full sound can be 
heard under normal conditions if the wall 
of the chest is very thin, under such circumstances the vibra- 
tion of the lung being unusually audible. 

Exaggerated pulmonary resonance oc- 
curs : 

1. If the lung is much inflated with air (emphysema). 

2. If the lung is abnormally distended with air as it oc- 
curs at the border of pleural exudate. 

3. In pneumothorax. 

If the dull or flat percussion sound is heard where 
the sound should be resonant, it always signifies disease. It 
occurs : 

1. If the lung tissue becomes dense 
from 

a. Pneumonic hepatization: in contagious 
pleuropneumonia of the horse, and in contagious pleuro- 
pneumonia of the ox as a rule a large portion of the lung be- 
comes solid and liver-like, and emits, on percussion, a dull or 
flat sound. In catarrhal pneumonias the pulmonary sound is 
not so flat, because the solidification of the lung is not com- 
plete, the morbid process appearing in the form of more or less 
isolated centers or foci which are not entirely void of air. In 
hypostatic, metastatic, and ichorus pneumonias, swin plague, 
dog distemper, verminous pneumonia and tuberculosis the 
percussion sound is not diffusely dulled, but a dull sound is 
emitted over the dense diseased centers only. 

b. Chronic interstitial pneumonia com- 
bined with atelectasis. 

2. If tumors or neoformations are pres- 



"RESPIRATORY APPARATUS. 123 

e n t in the lungs : glanders, tuberculosis, carcinoma, sarcoma, 
echinococci, etc. 

3. If an airless, solid medium come be- 
tween the lung and the plexi meter. 

Inflammation, swelling of the thoracic wall (after mus- 
tard applications) ; neo formations on the pleura; collection of 
considerable fluid exudate or transudate in pleuritis, conta- 
gious pleuropneumonia of the horse, contagious pleuro- 
pneumonia of the ox, and in swine plague. In the horse the 
presence of but a few litres of fluid in the chest cannot usually 
be determined. 

Pleuritic dullness is characterized by its horizontal upper 
boundary which shifts if the position of the body is changed, 
the contained fluid seeking the lowest level. This latter is 
most marked in small animals. 

The tympanitic percussion sound is abnormal 
when it occurs in the thorax. It appears : 

1. In collapse of the pulmonary tissue 
from a retraction of the lungs in the presence of pleuritic exu- 
date. The collapsed lung floats upon the exudate, hence above 
the horizontal line of dullness a tympanitic zone exists. 

a. In the first and last stages (resolution) of pneumonia. 

b. If numerous, small tumors occur in the lungs and the. 
pulmonary tissue amid them is collapsed. 

2. If caverns, or large bronchiectases 
[morbid dilatations of the bronchi] are present in the Lings. 
The intensity and clearness of the tympanitic tone depends 
upon whether the cavities momentarily contain air or exudate. 

The tympanitic percussion sound has a metallic tinkling 
tone when the walls of the air-containing cavity are smooth 
and distended. 

The cracked-pot resonance. [This resembles the sound 
produced by striking the hands, loosely folded across cadi 
other, against the knee, the contained air being suddenly forced 
out between the fingers — Loomis]. It occurs in the thorax 



124 CLINICAL DIAGNOSTICS. 

when a large air-containing cavern is in direct communication 
with a bronchus. Forcible percussion causes some of the air 
to be suddenly driven out of the cavern into the communicat- 
ing bronchus, thus inducing this peculiar resonance. The 
cracked-pot resonance, however, does not 
always indicate the presence of a cavern 
in the lung. 

3. In pneumothorax. 

4. In prolapsus of bowel into the thoracic 
cavity through the ruptured diaphragm. 

X. Auscultation of the lungs. 

During breathing, when the air enters the lung and causes 
it to move, sounds are produced. The occurrence and charac- 
ter of these sounds furnish important data in regard to the 
condition of the air passages and of the surface of the lung. 
The intensity of the sounds varies with the depth of the res- 
pirations ; when the breathing is forced they are augmented. 
Therefore, to make them more audible it is sometimes advisa- 
ble to exercise the patient before auscultating. The sounds 
may also be made more distinct by holding the nostrils shut 
for a few moments. The partial closing of the nostrils, how- 
ever, recommended by some, is not admissible, as it induces 
a stenotic tone which might prove misleading. 

a. The vesicular murmur. In auscultating the thorax 
over healthy lung, we perceive a soft, sipping sound, the vesic- 
ular or alveolar murmur. The sound can be imitated by 
softly pronouncing the letter "v." It begins with the inspira- 
tion, increasing as the inspiration continues, and becomes at 
expiration, a fainter, shorter sound, having the character of a 
softly aspirated letter "f." 

As a rule the murmur is softer and less distinct in the 
horse than in the ox. 

As with the laryngeal respiratory sound, so are other 
sounds originating in the upper air passages transmitted to the 



RESPIRATORY APPARATUS. l"---> 

lungs These are rattling throat sounds, wheezing, groaning, 
etc & Their appearance in the chest has no diagnostic signifi- 
cance. 

An exaggerated vesicular murmur occurs: 
1. If the respirations are intensified, therefore in physio- 
logical and pathological dyspnea. 

2 If it is compensatory; that is, if one portion of the 
lung is required to perform extra work for another portion 
which is diseased and incapable of taking part in the respira- 
tory act. [For instance, where one lung does the duty of its 
fellow which is diseased.] 

3 If a bronchitis is setting in, the lumen of the bronchi 
being contracted by swelling of, or collections of exudate on, 
the mucous membrane. The exaggerated vesicular murmur 
in such cases is a symptom of great diagnostic importance. 

\ diminished or feeble vesicular murmur occurs: 

1. If the thoracic wall is thickened from fat accumula- 
tions or disease: swelling, neoformations. 

2 If the air cannot enter the vesicles 
in consequence of great swelling or plugging of the larger 
bronchi: severe bronchitis. 

3. If the exchange of gases in the lungs 
is impaired: emphysema, beginning hepatization, and a 
partial compression of the lungs by pleuritic exudate. 

Absence of the vesicular murmur, and no other sounds 
present in the lung [i. c, total absence of any pulmonary 

sound] occurs: 

1. If pleural exudates or tumors have displaced the lung 

tissue : 

2 Rarely in severe vesicular pulmonary emphysema, or a 
complete occlusion of a bronchus preventing access of air into 
a certain portion of the lung. 

Jerking, interrupted respiratory sounds are often produced 
by animals voluntarily, from restlessness or fear. In such 
cases it is heard in both lungs. Pathologically it is 



126 CLINICAL DIAGNOSTICS. 

confined to certain portions of a lung, 
and is observed when the free entrance of air into the vesicles 
is made difficult by a contraction or occlusion of the bronchi 
(bronchitis). 

b. Bronchial tones. The bronchial respiratory sound 
is normal in the larynx and trachea ;its appearance in 
the chest is always a sign of disease. It 
is audible only when the bronchi are free and the vesicles con- 
tain no air. 

Bronchial respiration displaces vesicular respiration : 

1. If the vesicles are filled with exudate, therefore in all 
pneumonias, especially in contagious pleuropneumonia of the 
horse and in contagious pleuropneumonia of the ox. To be 
heard, however, the hepatized portion of the lung must be of 
the size of a double clenched fist and lie next to the costal 
wall. ' 

2. If the lungs are compressed by pleuritic exudate 
(atelectasis). The compression must be complete, for if the 
vesicles contain air at all a feeble vesicular murmur can still 
be heard. 

A special variety of bronchial respir- 
ation is the amphoric respiration, which is a bruit, of a char- 
acter like the sound produced by gently blowing across the 
mouth of a narrow-necked bottle. In animals it is rare, but 
appears if large caverns in the lung communicate with bronchi 
(pulmonary gangrene) . On percussion, in place 
of the d ul 1 e d sound which is usual w h e n 
the respiration is bronchial, a tympanitic 
tone or a cracked -pot resonance is heard. 

That bronchial respiration may become audible the bronchi 
must not be occluded ; if they are filled with masses of exu- 
date, no respiratory sound is heard. A forcible cough, how- 
ever, may dislodge and eject the exudate and the bronchi be- 
-ccme free again. 

c. The vague or indefinite respiratory sounds. Such 



RESriRATORY APPARATUS. 127' 

sounds are spoken of when it can not be determined whether 
they belong to the vesicular or bronchial respiration. Vague 
respiration is heard if hepatization is setting in, the vesicular 
murmur becoming weak and the bronchial sound just begin- 
ning. A slight compression of the lungs or partial occlusion 
of the bronchi with exudate may also produce it. 

d. Rales or rhonchi. Rales are heard in disease and 
appear if the bronchi or a cavern in the lung contain movable 
exudate against which air is forced. 

1. Moist rales appear if the bronchi contain a 
quantity of light, fluid exudation (bronchitis). The larger the 
bronchi and the greater the quantity of exudate they contain, 
the larger will be the b u b b 1 e s and the coarser the rales. 
In the large bronchi and in caverns, the rales may assume a 
gurgling or bubbling character. We also distinguish medium, 
coarse, and fine rales ; the latter originating in the bronchioli. 
Rales may occur irregularly and are not always of like 
intensity. Sibilant rales are heard only at inspiration, increas- 
ing in intensity as the inspiration progresses ; coughing may 
temporarily remove them. The intensity of rales depends upon 
the extent of the disease and the topographical position of the 
diseased part. 

Moist rales originate from the to-and-fro movement of 
mucus [pus, blood, liquid exudate], the forming and bursting 
of bubbles, and the vibrations produced by these acts. Accord- 
ing to whether rales attend vesicular, bronchial or amphoric 
respiration their tone will vary ; metallic rales as a rule accom- 
pany bronchial respiration. 

By crepitant rales: we understand very fine, crackling 
noises, which resemble the sound heard when the ear is rested 
very lightly upon the haired skin of an animal. Taking their 
origin into consideration they can be grouped with neither the 
moist nor the dry rales. They originate from a separation, at 
inspiration, of the adhering walls of the bronchi and vesicles. 
They appear in 1 renchi !:t! , : !:r.; nary edema and in the 



128 CLINICAL DIAGNOSTICS. 

exudative (early) stage, and last stage (resolution) of fibrin- 
ous pneumonia (contagious pleuropneumonia of the horse). 

2. Dry rales appear if a small quantity of a tough 
bronchial secretion is present, or if the mucous membrane is 
greatly swollen. These conditions produce stenosis of the 
bronchi, hence the sound is stenotic and of a sonorous, hum- 
ming, hissing, squeaky, whistling, (sibilant) character. Dry 
rales most commonly attend chronic diseases : chronic bron- 
chitis, compression of the bronchi by nodules (tuberculosis, 
chronic pneumonia) and tumors (echinoccocci). In the 
echinococcus disease of the ox the rale has a peculiar (quurk- 
send) character. 

A wheezing, crackling, whistling or piping, rale-like 
sound is heard in interstitial emphysema of the lungs. It is 
most pronounced during expiration. 

e. Pleuritic friction sounds. Normally the pulmon- 
ary pleura plays noiselessly upon the costal pleura during the 
movements of each respiratory act. If, however, the pleurae 
become rough and dry from inflammatory deposits upon them, 
a sound is produced at respiration. This sound is best heard 
where the movement of the pleural laminae is greatest, there- 
fore near the sharp borders of the lung. The intensity of pleu- 
ritic friction sounds depends upon the extent of the disease 
[pleuritis]. They are audible as grazing or rubbing sounds 
just below the ear; if there is an intimate adhesion the sound 
is emitted in a series of jerking, creaking, or crackling noises. 

A pleuritic friction sound appears in 
d r v or fibrinous pleuritis only. It is most 
frequently heard in contagious pleuropneumonia of the horse 
and in contagious pleuropneumonia of the ox. It rarely 
occurs from the presence of tumors or neoformations upon the 
pleura. In tuberculosis, as a rule, no fric- 
tion sound is heard. 

Pleuritic friction sounds are easily confused with rales. 
Friction sounds are heard regularly at inspiration and 



RESPIRATORY APPARATUS. 129 

expiration, may sometimes even be felt, and occur most fre- 
quently in a series of abrupt, jerking noises upon which cough 
has no influence. Rales are commonly more pronounced 
at inspiration than at expiration, are not jerking in character, 
and are removed or modified by cough. 

Diseases of the Respiratory Apparatus. 

a. Cavities of the Head. 

Acute nasal catarrh. Rhinitis catarrhosa. Congestion of the 
mucous membranes, serous or mucous, rarely mucopurulent nasal 
discharge. Only when disease is severe is mild fever present; 
transient swelling of the submaxillary lymph glands. 

Chronic nasal catarrh. Mostly unilateral. Discharge often 
mucopurulent or light colored and "glassy" in appearance; Quan- 
tity varies. Nasal mucous membrane pale, sometimes catarrhal 
erosions. Enlargement of the submaxillary lymph glands. ^ 

Chronic catarrh of the superior maxillary and frontal sinuses. 
Symptoms of unilateral chronic nasal catarrh. When head is 
lowered discharge suddenly increases. Bulging of the diseased 
sinuses; if filled with exudate flat sound on percussion. 

Tumors in the cavities of the head. Most common are sar- 
comas in the sinuses and polypi in the nasal cavities. Chronic 
nasal discharge, enlargements, wheezing respiratory sounds, sub- 
maxillary glands also diseased. 

Parasites in the cavities of the head. Larvae of Oestrus ovis 
in the sheep, pentastomum taenioides in the dog. Sneezing, nasal 
discharge, wheezing respirations, brain symptoms. 

b. Larynx and Bronchi. 

Acute laryngeal catarrh. Laryngitis acuta. Cough which is 
at first dry and painful, later more moist. When disease is severe: 
mild fever, accelerated pulse, dyspnea with laryngeal stenotic 
sound. 

Croupous laryngitis. Sudden fever, sometimes chills. Per- 
sistent, hacking cough. Loud laryngeal stenotic sounds, great in- 
spiratory dyspnea. 

Edema of the glottis. Suddenly appearing severe inspiratory 
dyspnea, loud wheezing or shrieking respiratory noise, head held 
extended. Stenotic sound does not disappear by partially closing 
the nasal openings. Peracute course. 

Chronic laryngeal catarrh. Cough, especially when the animal 
is first brought out into the air and at work. 

Roaring. Hemiplegia laryngis sinistra. An atrophy of the 
muscles of the larynx due to a paralysis of the inferior laryngeal 
nerve (recurrent), which causes an inspiratory sound. No fever, 



130 CLINICAL DIAGNOSTICS. 

no catarrhal symptoms. Prolonged hoarse cough with return 
sound. Inspiratory sound when respirations are forced. Partial 
closing of the nasal openings causes sound to cease. 

Acute paralysis of the larynx. Suddenly appearing severe 
inspiratory dyspnea, which is apparent when the animal is at rest 
or slightly excited; loud whistling or shrieking respiratory noises, 
anxiety, restlessness. Partial closing of the nasal openings dimin- 
ishes the sound. General condition not disturbed. 

Acute bronchial catarrh. May only be diagnosed when dis- 
ease is well developed. Fever, accelerated pulse, dyspnea, cough 
which is at first dry, later loose. Full sound on percussion. On 
auscultation, rales which depend as to character upon the seat 
and quantity of the exudate. 

Chronic bronchial catarrh. No fever. As a rule a short, dull, 
weak cough. Dyspnea not pronounced at rest; at work marked. 
Sometimes a fine-foamy, serous nasal discharge. 

Verminous bronchitis. Lung-worm plague. Develpps slowly 
under symptoms of bronchial catarrh with prolific exudation. In 
mucus: parasites, eggs, or embryos of Strongylidae. Later, 
anemia, cachexia and death. 

Strongylus filaria in sheep and goat; strongylus micrus in ox; 
strongylus paradoxus in swine, and strongylus syngamus in fowls. 

c. Lungs. 

Pulmonary congestion and pulmonary edema. Sudden ap- 
pearance. Severe mixed dyspnea up to 100 respirations per min- 
ute. Percussion normal, auscultation: exaggerated vesicular res- 
pirations, crepitant rales, rhonchi. 

Pleurodynia. This is a congestion of the lungs combined with 
severe pains in the thoracic walls. General apathy, excessive dila- 
tation of the thorax, which is "held." Groaning. Respirations 80 
per minute, superficial. Temperature high-normal, pulse accel- 
erated. Super-resonant sound on percussion, feeble vesicular 
murmur. 

Catarrhal pneumonia. Bronchopneumonia. Begins usually as 
catarrhal bronchitis. High, intermittent fever, painful cough. 
Only when disease is extended can pneumonia be appreciated; 
circumscribed patches of dullness on percussion; vesicular mur- 
mur feeble, rarely bronchial respirations. 

Gangrene of the lungs. Fever. Breath at first of a sickening, 
sweetish odor, later stinking. Discolored greyish-brown, tena- 
cious nasal discharge. Percussion: tympanitic sound, cracked-pot 
sound; at periphery of necrotic centers, dullness. Auscultation: 
large rales, bronchial respiration, amphoric sound. Not infre- 
quently combined with pleuritis. 

Alveolar emphysema. May only be diagnosed when well de- 
veloped. Expiratory dyspnea with "double-pumping" of the 
flanks, protrusion of the anus. Cough: short, dull, weak. Super- 



RESPIRATORY APPARATUS. 131 

resonant percussion-sound, field of percussion enlarged posteriorly. 
Auscultation shows the vesicular murmur to be diminished. 

Interstitial pulmonary emphysema. Suddenly appearing mixed 
dyspnea. Cough very superficial or absent. Super-resonant per- 
cussion sound with tympanitic accessory sound extended poster- 
iorly. A piping sound in auscultation. Emphysema of the skin 
frequent. 

Echinococcus disease. Ox. Diagnosis is only possible when 
large numbers of the echinococcus bladders are in the lungs. No 
fever. Dyspnea. Cough weak and blowing. Percussion dulled 
in patches or tympanitic. Vesicular respirations diminished. 

d. Pleura. 

Pleurisy. Pleuritis. Fever depending upon the character of 
the inflammation. Respirations accelerated and dyspneic. Fre- 
quent, painful, weak cough. Horizontal line of dullness on per- 
cussion above which a tympanitic sound is observed. Percussion 
will vary with the position of the body of the patient. In early 
stages friction sounds are heard on auscultation, later when much 
effusion of exudate takes place no respiratory sounds are audible. 

Pneumothorax. Attends interstitial emphysema of the lungs 
or penetrating wounds in the chest wall. Tympanitic percussion 
sound in the upper portions of the thorax. Severe dyspnea. 

e. Infectious Diseases Which Involve the 
Respiratory Apparatus. 

Contagious pleuropneumonia of the horse. (Brustseuche). 
This is a contagious pneumonia affecting the parenchyma of the 
various organs and is usually attended with secondary pleuritis. 
1. Stadium incrementi begins with high fever, yellow discolora- 
tion of the visible mucous membranes, general weakness, crack- 
ling of joints. 2. Acme. Does not appear before the second or 
third day. Symptoms of fibrinous pneumonia with or without 
pleurisy, usually unilateral. Rusty brown nasal discharge, empty 
percussion sound with resistance under the hammer, bronchial 
respirations. Pleuritis: Empty percussion sound limited by a 
horizontal line above which is a tympanitic zone. Friction rounds 
which soon pass away, later no sound or bronchial respiration. 3. 
Stadium decrementi. The crisis appears in 7 or 8 days, tempera- 
ture within 24-36 hours down to normal, all other symptoms, also 
pulse frequency gradually disappearing in 8 days. Complications: 
pleurisy, acute myocarditis. Resulting diseases: pulmonary gan- 
grene, abscesses in the lungs, chronic pneumonia. 

Scalma (Dieckerhoff) is a diffuse, infectious bronchitis with 
subacute course. 

Tuberculosis. Tuberculosis is a contagious disease caused by 
the bacillus tuberculosis and characterized by the formation of 
very small inflammatory centers which soon undergo degenera- 
tion The disease develop, very slowly. Only advanced eases 



132 CLINICAL DIAGNOSTICS. 

can be diagnosed by physical examination. Symptoms will vary 
with organ affected. Very often general emaciation. 

1. Pulmonary Tuberculosis. Respirations often unchanged. 
Sometimes mucopurulent nasal discharge, especially after cough- 
ing. Cough regularly present. It is at first vigorous, but later 
becomes weak and not infrequently in paroxysms. Coughing may 
be induced by trotting the patient or by temporarily closing the 
nostrils, if it does not occur spontaneously. Percussion rarely 
reveals much. Auscultation more valuable, especially after exer- 
cise: vesicular murmur exaggerated, rough; rales and vague 
sounds. Great tubercular enlargement of the mediastinal lymph 
glands induces chronic bloating. 

2. Udder Tuberculosis. Begins in one or more quarters in 
the form of circumscribed, firm inflammatory centers which con- 
tinue growing larger. A'fter milking more noticeable. The supra- 
mammary lymph glands are enlarged and often nodular. 

3. Uterine and Vaginal Tuberculosis. Frequent periods of 
heat; animal does not conceive; vulva asymmetrical or sunken. Fre- 
quently mucopurulent nasal discharge. On mucous membrane 
small nodules and ulcers size of a pin head. Orificium uteri rarely 
closed. Uterus enlarged diffusely or in form of nodes. Fallopian 
tubes may be felt as tortuous, firm strands with nodules along 
their course. 

4. Brain Tuberculosis. Disturbance in movements and hold- 
ing of head. Twitchings and spasms. Often lie on one side, 
unable to arise. Symptoms may occasionally be acute. 

Strangles. Coryza contagiosa is an infectious catarrh of the 
mucous membranes of the upper respiratory passages with sec- 
ondary, purulent inflammation of their corresponding lymph 
glands. Begins with fever of intermittent character. Pulse at 
first little increased but may reach 80. Nasal discharge serous, 
mucous or purulent, usually bilateral and profuse. In 3 or 4 
days at latest inflammatory swelling of the submaxillary lymph 
glands, which in 4 to 8 days later have abscesses formed in them. 
Pharyngitis frequently concomitant. Dysphagia, abscess forma- 
tion in the subparotid and retropharyngeal lymph glands. If 
larynx is involved: cough, loud inspiratory noises. In ©Id horses 
disease often limited to the pharynx. 

Glanders, malleus, is a contagious disease of solidungula, 
caused by the Bacillus mallei, characterized by the formation of 
nodules and abscesses in the respiratory mucous membrane and 
skin. On the nasal mucous membrane we find gray nodules as 
large as millet seeds, transparent and surrounded by a red zone. 
The nodules become yellow, degenerate, form ulcers with raised 
and jagged borders and lardaceous bottom. Nasal discharge slight,, 
frequently unilateral, varyingly sticky, slimy, purulent, occasionally 
discolored and bloody. Intermaxillary lymphatic glands en- 
larged, knotty, firm, adhering to bone or skin. In skin and sub- 
cutis rather flat, painful, hot nodules varying in size up to that 
of a hen's egg, these break, discharge discolored pus and become 



DIGESTIVE APPARATUS. 133 

ulcerous. Lymphatics efferent and afferent to these nodules are 
enlarged to thickness of a finger. See also specific examination 
for glanders. 

Contagious pleuropneumonia of cattle is a- contagious crou- 
pous interstitial pneumonia. We distinguish an occult stage 
which is marked by a slight cough, fever, and slight dyspnea. In 
the acute stage we have distinct fever — 41°C [105. 8°F] and the 
symptoms of an acute pleuropneumonia. Great dyspnea, weak, 
short cough, some nasal discharge, extended empty sound on per- 
cussion, friction bruits, bronchial respiration, rales. Appetite, 
rumination and secretion of milk suspended. 

Malignant catarrhal fever is a specific disease of the ox, has 
a subacute course and affects chiefly the respiratory and digestive 
mucous membranes, and the brain. Disease is introduced with 
chills. Great mental depression, muscular trembling, stiffness, 
sometimes inability to stand. Conjunctivitis and keratitis. Diph- 
theritic inflammation of the mucous membrane of the nose, 
sinuses of the head, trachea and mouth, rattling, wheezing and 
breathing. No appetite, secretion of milk suspended. 

Distemper of dogs is a very contagious disease that is char- 
acterized chiefly by catarrhal affections of the mucous membranes. 
Symptoms quite varied; we distinguish: catarrhal, nervous and 
exanthematous distemper. Symptoms of the disease develop 
slowly. Animals are indisposed, conjunctivitis, keratitis, vomiting, 
disturbed appetite, slimy nasal discharge, cough, dyspnea, tym- 
panitic and occasionally dulled sound on percussion of lungs, rales. 
Spasms affecting the whole body or only certain groups of mus- 
cles, general muscular weakness, paralysis. Vesicular and pustular 
exanthema. 

8. Digestive Apparatus. 

Diseases of the digestive apparatus are common in domes- 
tie animals. Their diagnosis is, in some respects, far more 
difficult than that of the respiratory apparatus because the 
organs concerned are not as accessible to examination. For 
this reason every possible factor must receive most careful 
consideration. We observe these in the following order: 
i. Food and Drink. 
ii. The Buccal Cavity. 
in. The Pharynx and Esophagus. 
IV. Rumination, 
v. Vomiting. 
VI. The Abdomen, 
vn. The Intestinal Evacuations. 



134 CLINICAL DIAGNOSTICS. 

I. Food and Drink. 

Before examining the various organs of the digestive 

apparatus, we must note the animal's appetite for food and 

drink as well as the character of these latter, also observe the 

way in which the animal takes its food, masticates and 

swallows it. 

a. Appetite for Food. The appetite that an animal manifests 
for certain food depends in part on its palatability and in part on 
the degree to which the animal has become accustomed to it. 
This must always be borne in mind when probing for 
the cause of poor appetite, and hence an inspection of the 
food must not be neglected. Individual appetites vary widely. 
One horse may be a good feeder, another a poor feeder, both 
may enjoy perfect health. High strung horses often refuse their 
food after active exercise, but their appetite returns after a short 
rest. A change of stable or unaccustomed loneliness has a marked 
effect on the appetite of some sensitive horses. Of the various 
grains horses prefer oats and indian corn and of the grasses 
sweet timothy or meadow hay. Oats is by far the most suitable 
grain to feed a horse. 

In all serious cases of disease the appetite is more or 
less affected, hay or straw are usually the last part of the 
ration refused. Defective appetite alone is 
never an indication of any particular dis- 
ease. As a rule, complete loss of appetite is an unfavor- 
able symptom ; on the other hand, a good appetite in the 
course of a severe disease may be regarded as a favorable 
symptom. 

Desite for water depends in the first place on 
the amount of water contained in the feed; dry feed requir- 
ing more water than green feed ; of course some water is 
required in both cases. The demand is also affected by the 
amount of water given off through the skin, kidneys and 
intestines. Many horses are very sensitive in the matter of 
impure water, some even refuse "pure" water if of a differ- 
ent kind than that to which they have been accustomed 
[e. g. spring water and rain water]. 

The desire for water is diminished in colic and in all 
serious gastric and intestinal affections, providing no di-ar- 



DIGESTIVE APPARATUS. 



rhea exists; horses with acute cerebritis also refuse water. 
Continued refusal of water is on the whole considered as an 
unfavorable sign; when horses with colic drink water it is 
regarded as a favorable sign. 

' Thirst is increased in the course of various diseases : 
1. Animals with fever like small sips of fresh water 
at frequent intervals. 

2 When the crisis occurs in influenza or contagious 
pleuro-pneumonia of the horse, increased renal 
secretion and thirst go hand in hand. 

3 Exudative pleuritis and peritonitis. 

4 Diabetes insipidus of horses is attended with 
marked increase of thirst; several pailfuls are 
taken at a time. - ' 

5. Gastric and intestinal catarrh [diarrhea] of dogs 
—attended with frequent vomiting. 
Bv the term perverted or depraved appetite we mean the 
craving of unnatural food by otherwise healthy [?] animals 
As a rule this is a very important symptom. Of course this 
condition must not be confounded with playfulness ot young 
animals which gnaw at. bite and even swallow almost any- 
thing of convenient consistency and size. Thus cattle will 
lick at one's clothes, dogs eat blades of grass. 

4 craving for alkalies is pathological: e. g. straw soiled 
With urine and feces, whitewash, etc., on walls, wood; acids 

1,4 ^SESS^ i-*«iw «**-«. «!• . .do* i^ 

wood stones, and similar objects is observed in lick disease 
oTcattle, and wool eating of sheep; in rabies the same is 

^T'Manner of taking food. Healthy horses grasp the 
food with their lips and pass it into the mouth, then with the 
aid o the tongue and cheeks it is forced between the mo an, 
sLp and gois do likewise. Healthy cattle grasp their food 
with the extended tongue, curved like a hook. 



136 CLINICAL DIAGNOSTICS. 

In horses the following changes are observed : 

1. In inflammatory swelling of lips and "cheeks as well 
as in paralysis of the cheeks (facial or ?th nerve), horses 
take up their food with their teeth and experience difficulty 
in getting it into the mouth. 

2. In cerebral depression they show similar peculiari- 
ties ; while drinking they may insert the nostrils below the 
level of the water and "masticate" it. 

3. In tetanus feeding is very laborious ; mastication and 
suction movements are impossible because the spasmodic con- 
traction of the masseter muscles has closed the buccal cavity. 

In cattle normal feeding is disturbed in inflammatory 
affections of the tongue (actinomycosis), this organ often 
be< oming hard and rigid (woody tongue). Cattle thus 
aFccted grab their food like dogs. 

The manner of drinking wa t e r must also be 
observed. Normally only dogs and cats lap their drink. 
When the facial nerve is paralyzed animals must insert the 
whole mouth into the water so that they can get it near 
enough to the pharynx to swallow it. 

c. Mastication. The briskness with which this act is 
performed bears a direct relation to the palatability of the 
food and the appetite of the animals ; healthy horses and cat- 
tle make 60-100 masticatory movements per minute. 

Masticatory movements arc conspicuously retarded in 
cerebral depression, in the course of severe fevers, and in 
acute and chronic hydrocephalus. The animals cease masti- 
cating for some time, seem "absent minded," and forget to 
eat. This often happens while the mouth is full of feed, and 
pieces of hay and straw sticking out of it. 

Mastication is made difficult in paralysis of the facial 
nerve; here the food collects in large masses in the lower 
part of the mouth ; it is also observed in tetanus or spasms 
of the masticatory muscles due to other causes. 

Mastication is impaired and laborious when mechanical 



DIGESTIVE APPARATUS. 



137 



defects of the teeth exist. Shear jaws, and irregular teeth, 
projecting teeth, etc. The animals masticate one-sided, cau- 
tiously and "easy;" they don't masticate thoroughly, the food 
is "crushed and bruised" but not "ground." 

Mastication is painful when acute inflammatory condi- 
tions exist in the cheeks, temporo-maxillary articulation and 
in the intermaxillary space as they occur in the course of 
distemper of horses. Mastication may be voluntarily inter- 
rupted. If sharp or pointed objects like nails, needles, splin- 
ters of wood, etc., are taken up with the food horses open 
their mouths wide and allow the contents to drop out, aiding 
with the tongue. They do the same thing when injuries 
are produced by sharp teeth or displaced teeth (alveolar 
periostitis) ; sudden pain, produced by biting on a diseased 
or loose tooth, produces the same effect. Horses with dis- 
eased teeth frequently drop small masses or balls of. food 
into the manger, "quibbing." Some horses suddenly raise 
their head while masticating and hold it sideways, open the 
mouth and continue masticating in a cautious manner, at the 
same time making slow lateral movements with the lower 
jaw. Varied as the symptoms that occur in 'the course of 
different affections of the teeth may be, they all have 
one thing in common, they make mastica- 
tion difficult and painful. 

In dangerous diseases we often observe gnashing of the 
teeth, at the same time this is not a "prognostically unfavor- 
able" sign. 

d. Deglutition. Deglutition is the closing act of 
feeding. It is described as occurring as follows: The lips 
are closed and the jaws are set together, then the tip, the 
back and the base of the tongue are successively pressed 
against the palate and thus the contents of the buccal cavity 
are forced into the pharynx. By contraction of the muscles 
of the pharynx in front of the food mass the peristaltic mo- 
tion thus inaugurated carries the bolus into the esophagus. 



138 CLINICAL DIAGNOSTICS. 

At the same time the pharynx is slightly raised and the pres- 
sure exerted on the epiglottis by the base of the tongue, 
which projects backward, closes the larynx and allows the 
food to glide over it. The nasal openings leading into the 
pharynx are closed during this act by a raising of the soft 
palate and a coming together of the borders of the posterior 
pillars of the fauces brought about by contraction of the 
muscles of the pharynx. 

A disturbance of normal deglutition 
is most frequently caused by inflammatory processes in the 
pharynx that cause infiltration and disturb the function of 
the local muscles. The result is not only a painful condition 
during swallowing but the closure of the larynx or nasal 
cavities may be incomplete. Accordingly we may observe 
manifestations of pain, extended head and neck, 
the animals often shaking their heads. Incomplete closure 
of the pharyngeal openings results in food particles entering 
the larynx or nasal cavities and giving rise to cough, or 
ejections of water, saliva or food through the nostrils (re- 
gurgitation), as the case may be. The degree to which the 
closure of the pharyngeal openings is imperfect, bears a 
direct relation to the severity of the affection. In mild cases,, 
fluid only is regurgitated, noticeable while drinking water. 
Later on as the case becomes aggravated, solids also pass 
out. When the affection is mild and restricted to one side 
the regurgitation may also be unilateral. Soft feed is more apt 
to cause regurgitation than are solid substances. An inflam- 
matory affection of the pharynx that causes difficulties in deg- 
lutition may be primary (pharyngitis), or secondary to other 
diseases :. distemper, morbus maculosus, anthrax. 

In addition, difficult deglutition is observed in: 

1. Paralysis of the pharynx in mycoses, parturient 
paresis, and rabies. 

2. Spasm of the pharyngeal muscles in tetanus. 

3. Tumors of the pharynx; actinomycoma, lymphoma. 



DIGESTIVE APPARATUS. 



139 



Besides the symptoms of difficult deglutition we observe 
in addition : salivation, foaming at mouth, ejecting food from 
mouth while coughing, retention and fermentation of food 
in mouth cavity. 




Inspection of the'.Mouth Cavity. 



II. The Buccal Cavity. 

We usually examine the buccal cavity by daylight and 
without the aid of instruments; artificial illumination with 
reflectors, lamps, or electric lights is sometimes useful but 
not necessary. 

Method of Examination. In the horse and ox the hand is 
passed into the month at the bars, the tongue ^jr^,^ 
the thumb pressed against the palate. This Procedure will, as a 
rule, cause the animal to open its mouth wide. Anot prac 

tical method consists in grasping with the hands, on i both i «de* 
the uooer lips at the commissures and resting the thumbs against 
he p Tate. In dogs and cats we grasp, with our hands the upper 
and lower jaws, at the same time pressing the lips between the 
teeth hereupon the animal opens its mouth wide enough to 

^^es&animals must first be secured and then 'towels or 
cords are 'passed between the dental arches, and by means of these 
the jaws are forced apart. 



140 CLINICAL DIAGNOSTICS. 

In examining the mouth the following should be ob- 
served : 

The temperature is elevated in fever and in local in- 
flammations of the mucous membrane, stomatitis and in 
pharyngitis. 

Secretion of Saliva. Secretion is diminished 
in all acute febrile diseases, severe intestinal affections, and, 
as a rule, in colic. 

An abnormal quantity of saliva in the mouth 
results either from the fact that the animal does not swallow 
the normal secretion (dysphagia) or that an abnormal secre- 
tion has occurred, as in simple catarrhal or traumatic stoma- 
titis, diseased teeth, foot and mouth disease, stomatitis pustu- 
losa contagiosa, malignant catarrh, mycoses, etc. The saliva 
passes off in the form of clear strands or in the form of 
foam produced by masticatory movements. In epilepsy this 
foam is observed at the commissures of the mouth. 

Odor from the mouth. An "insipid sweetish" odor is 
observed when decomposing food-particles, epithelial cells or 
saliva in the course of stomatitis catarrhalis, are present. A 
putrid odor is produced by decomposition of nitrogenous 
substances. Exudates are present in malignant catarrh and 
stomacace in dogs. A carious odor is produced by suppura- 
tive processes in bones, especially in alveolar periostitis. 

Specific morbid conditions. Clamminess of the buccal 
mucous membrane occurs in digestive disorders (loss of appe- 
tite) ; reddening and szvclling of the mucous membrane with 
loss of substance is observed after the action of irritants and 
caustics [chloral hydrate pills]. Simple catarrh is attended 
with similar but milder symptoms. 

Punctiform hemorrhages occur in morbus maculosus 
and leucemia. Nodules, pustules and ulcers in stomatitis 
pustulosa contagiosa. Ulcers on the gums in stomatitis 
ulcerosa, calf diphtheria, swine plague, mercury and lead 
poisoning. Blisters in foot and mouth disease, small isolated 



DIGESTIVE APPARATUS. 141 

yellowish vesicles in stomatitis vesicularis. Wounds at the 
tongue tip and frenulum are produced by rough handling 
of the bridle bit; sharp teeth produce wounds on the inside 
of the cheeks, and sides of the tongue. 

Foreign bodies are of frequent occurrence in horses 
[corn cobs], dogs, and cats, rare in other animals; they con- 
sist of pieces of bone, needles, etc., occasionally ring-like 
objects slip over the tongue accidentally: e. g. cross sections 
of the aorta, intestines, trajchea. iron rings, etc., [rubber bands 
slipped on intentionally by children during play]. The symp- 
toms are: open mouth and salivation, attempts at removal 
on part of the animal, eating and drinking interfered with, 
the tongue swollen. % 

Careful manualas wellasocular exa m- 
i nation is often necessary to recognize 
these conditions. 

Condition of the teeth. Examination of the teeth of 
horses is of particular importance on account of the frequent 
occurrence of diseases and malformations of these organs. 
In dogs diseased teeth are also common. 

Abnormal position of the incisors (par- 
rot mouth and pike mouth) point to the existence of a similar 
defect in the molars. Parrot mouth is not an uncommon 
occurrence in high bred colts. In ruminants the incisors are 
normally loose. Carious incisors and molars occur in dogs 
in the course of rachitis, distemper, anaemia and stomacace. 
Careful examination of the molars 
with the aid of a speculum* is indicated when 
horses reject food after partial mastication, when they show 
any abnormal masticatory movements, and when large quan- 
tities of coarse food particles occur in the droppings. The 

*[For horses a speculum is not in all cases necessary for the detection of defects or 
other abnormal conditions of the teeth. By passing the hand into the mouth at the bars, 
at the same time pushing the tongue to the opposite side that organ is forced between 
the molar teeth on that side and the animal will voluntarily keep its jaws sufficiently 
separated to permit examination of the condition of the teeth without endangering the 
safety of the operator. The right molars are examined with the right, the left with the 
left hand, the operator facing the animal.] 



142 CLINICAL DIAGNOSTICS. 

friction surface and the lateral faces of the teeth can be 
examined simultaneously by letting the index and middle 
fingers glide over the former, the thumb and the remaining 
fingers over the latter. Abnormal conditions of the teeth 
can usually be felt far better than they can be seen. We 
should observe the presence or absence of sharp points, slant- 
ing friction surfaces, shear jaws, interrupted jaws, project- 
ing teeth, short teeth, carious and broken teeth, cavities, etc. 

III. Throat and Esophagus. 

Examination of the throat and esophagus is restricted 
to external inspection and palpation. 

Inspection. Diffuse swellings in the region 
of the pharynx occur in phlegmonous conditions of the 
mucous membrane (pharyngitis) . Circumscribed 
swellings indicate the presence of abscesses and tumors. 

Palpation. Increased temperature and sen- 
sitiveness indicate acute inflammation which may be 
either diffuse (pharyngitis) or circumscribed (development 
of abscesses) . The consistency. is firm, yet yielding ; 
even in abscess formation distinct fluctuation is rarely pres- 
ent here. Circumscribed painless swellings of firm consist- 
ency indicate the presence of tumors, usually melanosarcoma 
in old gray horses and actinomycoma in cattle. Palpation 
of the esophagus serves to detect the presence of for- 
eign bodies, mostly observed in cattle in the form of pieces 
of potatoes, apples, corn cobs, etc. Esophageal diverticula 
and stenoses cause periodically recurring occlusions of the 
esophagus. Ingestion of food causes the esophagus to dis- 
tend — sausage like. Such animals cease eating, or, when 
they attempt to eat or drink, regurgitation of the ingested 
mass through the nostrils takes place. 

Examination with a probe or probang has no special 
value ; the dilated esophagus, regurgitation, vomiting of 
food and symptoms of choking are sufficient to base upon 



DIGESTIVE APPARATUS. 1-13 

them the diagnosis diverticulum and stenosis, two conditions 
usually coexisting. On the other hand, the fact that a pro- 
bang can be passed freely through the esophagus does not 
exclude the presence of these conditions. 

IV. Rumination. 

Rumination is a specific physiological act of the digestive 
apparatus of ruminants. These animals feed by taking up food 
hurriedly and swallowing it after little or no mastication. After 
ingesting a sufficient amount of food in this manner, the latter, 
which by this time has become partly macerated by the saliva 
which accumulated with it in the rumen, is carefully rcmasticatcd. 
During this act the animals prefer a recumbent position. The 
food is forced into the mouth by a contraction of the second 
stomach or reticulum into which it previously passes from -the 
rumen. . Every cud is subjected to about 60 masticatory move- 
ments and is then re-swallowed, this time passing directly into 
the omasum and abomasum or true stomach through the esoph- 
ageal groove. The whole act of rumination requires from one 
to two hours. When cattle are driven or oxen put to work before 
they had time to finish ruminating, this act is temporarily sus- 
pended to be resumed at the next period of rest. 

Slight disturbances of the act of rumination can as a 
rule not be recognized as such. 

Considerable deviations from the nor- 
ma 1 or complete suppression of rumination alone are definite 
signs of disease. 

In the beginning disturbances in rumination due to dis- 
ease manifest themselves by a reduction in the number of 
cuds chewed in a certain time, by the number of masticatory 
movements applied to each cud before being swallowed and 
by die rapidity with which the animal masticates. 

The severity of the disease corresponds to the degree to 
which rumination is interrupted. In severe diseases rumina- 
tion ceases entirely. 

Rumination is disturbed in : 

a. [All severe febrile and painful affections, surgical 
diseases.] 

b. Gastric and intestinal disturbances, especially over- 
loading and paralysis of the paunch. 



144 CLINICAL DIAGNOSTICS. 

c. Traumatic inflammation of the stomach and dia- 
phragm. 

d. [All cachectic diseases.] 

e. [Many cerebral diseases.] 

Eructation or belching occurs normally in ruminants 
only. This consists in audible expulsion of paunch gases 
through the oesophagus and mouth. [Eructations become 
distinctly audible and abnormally frequent during fermentation 
processes in the paunch, slight tympanitis, etc. Sometimes 
they are accompanied by disagreeable odors (fermentations) 
but the character of the food also plays a role here (onions).] 

V. Vomiting. 

Vomiting is a reflex (involuntary) spasmodic evacua- 
tion of the stomach or paunch contents through the mouth 
or nasal passages. This act is assisted by simultaneous con- 
traction of the abdominal and inspiratory muscles. Imme- 
diately preceding the act of vomiting animals make a deep 
inspiratory movement. Vomiting is caused by indirect 
(rarely direct) stimulation of the vomiting center in the 
medulla oblongata. 

The ease with which vomiting occurs in our domestic 
animals varies with the species according to the anatomical 
construction and the degree of fullness of the stomach. Car- 
nivora, pigs, and birds vomit most readily and with greatest 
ease, ruminants less so. Horses rarely vomit. This is ex- 
plained by the anatomical structure and position of the stom- 
ach. [The stomach of the horse is comparatively small and 
even when filled does not always come into contact with the 
floor of the abdomen, hence is not easily affected by abdom- 
inal contractions.] 

Further, the spiral arrangement of the muscular coats, 
insertion of the esophagus at the middle of the stomach, its 
contracted and thickened wall at the point of insertion (in 
contrast to the funnel shaped thin walled structure of this 



DIGESTIVE APPARATUS. 145 

organ in other animals) and the large fundus of the horse's 
stomach must be considered in this connection. 

A vigorous contraction of the stomach will serve to over- 
come these obstacles and vomiting may occur in the horse. 
In such cases, however, there is always danger of rupture of 
the organ. This is the usual result when the stomach is well 
filled with food. Vomiting in the course of colic is therefore 
always a serious symptom. If, however, the stomach of the 
horse is moderately tilled with fluid contents, a rupture need 
not occur. In such cases the act of vomiting is usually not 
caused by an overloaded stomach but by direct stimulation of 
the vomiting center. (Chloroform narcosis, hemorrhages and 
inflammations near the medulla). 

V o m i t i n g is always a s y m ptora of dis- 
ease and occurs under the following conditions: 

a. During the presence of foreign bodies in the larynx 
or at the base of the tongue : pieces of bone, fish bones, 
needles, feathers, etc.. also when tough, stringy mucus col- 
lects in this region in the course of pharyngitis and laryngitis. 

b. Obstruction of esophagus. 

c. Gastric affections, overloading of stomach, gastritis, 
and in certain poisonings. 

d. Intestinal affections, such as prevent the normal 
progress of food masses through the lumen of the intestine 
and thus provoke antiperistaltic movements which cause the 
stomach to become distended with intestinal contents, irrita- 
tion of its mucous membrane, and vomiting. 

The character of the vomited material may often serve to 
determine the cause of the act and the origin (stomach or in- 
testine) of the ejected mass. 

VI. The Abdomen. 

Examination of the abdomen is conducted according to 
the following general rules. 

a. Inspection. The volume or circumference of the 



146 CLINICAL DIAGNOSTICS. 

abdomen in domesticated animals is subject to great variations 
and great care must be exercised here in diagnosis. For clini- 
cal purposes the size of the abdomen must always be con- 
sidered in connection with the general condition of the animal, 
its general make up, feed, care, etc. Animals habitually kept 
on voluminous food in ample abundance develop a voluminous 
abdomen. A good plan is to inquire of the owner as to the 
former or. usual condition of the animal in this respect. Cir- 
cumscribed enlargements are usually of interest from a sur- 
gical point of view. 

Abnormal distention of the abdomen may be due to: 

1. Pregnancy ; the form of the abdomen becomes barrel 
shaped — increasing bilaterally. 

2. Accumulation of abnormal quantities of food in the 
digestive tract (in horses the cecum and colon, in ruminants 
the paunch and other stomachs, in dogs the stomach). In 
these cases the distention is due either to increased consump- 
tion of food (overfeeding) or to accumulation of food taken 
in normal quantities during inactivity of the bowels (constipa- 
tion). In these cases the normal tympanitic tone is replaced 
by a dull one. 

3. The accumulation of gases produced by fermenting 
food. In this case the distention is in an upward direction, 
the hollow of the flank is raised, and the abdominal walls be- 
come distended (tympanitis, bloat). The rapid production of 
gas may be due to the character of the food [legumes, cruci- 
fera, etc.] or to suspended activity of the bowels. 

4. Accumulation of fluid (transudate and exudate) in 
the peritoneal cavity. This is occasionally seen in dogs, rarely 
in horses. In this case the distention is in a downward direc- 
tion, symmetrical and bilateral, fluctuation is observed and 
percussion reveals a dull area bounded above by a horizontal 
line. When a dog thus affected is raised to a vertical position 
the dull area is shifted (ascites). 



DIGESTIVE APPARATUS. 



147 



5. Tumors in the abdomen; liver (ecchinococci and car- 
cinoma), spleen (leukemia), glands, etc. 

6. Dropsy of foetal membranes. 

Abnormal reduction in sice of the abdomen may be due to: 
1. Long continued starvation, or, if in spite of good care, 
abundant food and sufficient rest an animal shows this symp- 
tom, we may conclude that lack of appetite is at fault (digest- 
ive disorders). 




W 



Fig. 36. 
— Dorsal and Ventral limits of area of percussion. — - — Attachment of diaphragm 
to ribs. N. Right kidney. L. Liver. H Reticulum. 
B. Manyplies. Labm. Stomach. 



2. In serious subacute diseases; in such sases the ani- 
mal's general condition may still be good. 

3. During or following severe diarrheas, or after colic 
when strong purgatives were prescribed. 

4. Violent contraction of the abdominal muscles in pain- 
ful affections of the hind legs. 



148 CLINICAL DIAGNOSTICS. 

Palpation. The object of palpation is to ascertain the 
consistency of the bowel contents and whether or not painful 
conditions exist. In ruminants the peristaltic motion of the 
paunch can also be observed by palpation. Palpation of the 
bowels per rectum is of especial value in large animals. 

In horses the abdominal walls are thick and tense ; this 
and the fact that during an examination the animals frequent- 
ly contract their abdominal muscles increases the difficulty of 
arriving at accurate results in judging of the condition of 
the abdominal organs, their contents, etc. In cattle the ab- 
dominal walls are thinner, hence the results of palpation are 
more accurate and satisfactory; in sheep this is true to a still 
greater degree. 

Dogs habitually contract the abdominal walls when these 
are manipulated, but soon relax them again. In dogs both 
sides are palpated simultaneously, and by exerting pressure 
from both sides toward the median line the entire abdominal 
cavity may be thoroughly examined. 

Palpation serves in the first place to inform us as to the 
degree of contraction (the tenseness of the abdominal walls 
and the consistency of the bowel contents ; the latter should be 
soft and easily compressible. If impressions are made by pres- 
sure they should soon be effaced by the effects of peristalsis. 
Large quantities of fluid bowel contents produce fluctuation. 
Neo formations (tumors) are recognized by the extreme resist- 
ance they offer to pressure. In dogs accumulated fecal masses 
[and intussuscepted intestines] can readily be felt. Foreign 
bodies in the stomach and intestines can also be detected by 
palpation providing the normal bowel contents are previously 
evacuated [medicines or clysters]. 

Another object of palpation is to ascertain painful condi- 
tions or abnormal sensitiveness. Even healthy horses are 
often extremely sensitive to pressure exerted on the abdomen 
and become restless when subjected to such an examination. 
Care must therefore be observed not to mistake these symp- 



DIGESTIVE APPARATUS. 149 

toms for something more serious. In cattle it is different, be- 
cause abnormal sensitiveness in these animals always points to 
the existence of important lesions. 

Sensitiveness to pressure between the Gth and 8th ribs 
(opposite the reticulum) points to the possibility of an injury 
to the diaphragm from a foreign body that penetrated the 
reticulum. In acute affections of the true stomach cattle 
evince symptoms of pain on palpation of the hypochondriac 
region. Palpation of the right flank in cattle, when intussus- 
ception of the small intestine exists, is also attended with 
symptoms of pain. Foreign bodies in the intestines of dogs 
produce symptoms of pain when pressure is exerted. 

In cattle the peristaltic movements of the paunch are an 
important consideration. Normally these can be felt in the 
hollow of the left flank at the rate of about two per minute. 
The food masses are moved from below upward and toward 
the right side. Every contraction of the paunch is attended 
by a slight rise in the hollow of the flank followed by a some- 
what more sudden drop or depression. Imperfect or slowed 
movements of the paunch point to the existence of some patho- 
logical condition (overfeeding, tympanitis, paresis of the 
paunch, peritonitis, adhesions of the paunch with the abdomi- 
nal wall). 

Palpation of the bowels per rectum. This is possible 
only in the comparatively large rectum and roomy pelvis of the 
horse and ox, but on the other hand the proportions are so 
large here that only a part of the abdominal region can be thus 
explored. In the region within our reach we can determine 
position and contents of the abdominal organs, also the pres- 
ence of foreign bodies and tumors. 

Method of procedure. To make a thorough examina- 
tion it is often necessary to introduce the arm full length. 
A shirt without a sleeve can be worn to advantage on such an 
occasion. [After carefully paring the finger nails] the arm 
should be well covered with oil, or soap (castor oil answers the 



150 CLINICAL DIAGNOSTICS. 

purpose well) and then, with the tips of the fingers forming a 
cone, the hand is carefully introduced into the rectum. Dur- 
ing the examination the animal's head (if a horse) is held up, 
and the forefoot on the side where the operator stands is 
raised, by an assistant. Nervous or excitable horses can be 
secured with a twitch or the operator can protect himself 
against kicks by having the animal standing close to a stable 
partition, the operator standing on the opposite side. The left 
half of the abdominal cavity can be examined most satisfac- 
torily with the right hand, the right half with the left hand. 
Since perforations can be produced it is advisable to proceed 
with the utmost care in making rectal examinations. 

If accumulated food masses, contraction of the rectum, or 
the presence of gases retard the easy introduction of the hand, 
simultaneous infusions of water should be given to facilitate 
the operation. It is always a good plan to insert the arm 
nearly its full length before beginning our examination. In 
this way a long piece of the rectum slips over the arm and 
there is less danger of pulling or straining the mesentery. 
This danger decreases as the length of the mesentery increases 
anteriorly. 

Exploration per rectum is indicated in chronic colic and 
in all cases of colic in stallions and cattle. Palpation may 
serve to determine the following points : 

I. Fullness and position of the bowels. 
The separate regions of the intestines can be definitely recog- 
nized-only when they are filled with food. Mere distention 
with gases does not always enable us to recognize with cer- 
tainty the identity of parts. When the bowels are empty or only 
partially filled with fluids or gases it may be impossible to dis- 
tinguish between the large and the small intestine. The longi- 
tudinal muscular bands of the large intestine of the horse are 
the only means of differentiation, and these must be sought. 
Manual exploration per rectum enables us to recognize food 



DIGESTIVE APPARATUS. 151 

accumulations or impactions in the following divisions of the 
bowels : 

a. Impaction of the floating colon. This is of frequent 
occurrence in its posterior region and can then be easily rec- 
ognized (rectal paralysis) ; constipation in the floating colon is 
recognized by the nodular character of the 'surface and the sin- 
uous course of the bowel. Its volume is appreciably less than 
that of the colon or cecum. 

b. Impaction of left colon. When well filled with im- 
pacted food masses the pelvic flexure projects into the pelvic 
cavity and frequently toward the right hand. This flexure is 
recognized by its great volume, its curvature and the short 
mesentery uniting the two superposed layers of the left colon. 

c. Impaction of cecum. The base of the cecum is situ- 
ated in the upper portion of the right flank and is attached to 
the spinal column by means of a mesenteric fold and the pan- 
creas. When distended with food-masses its great curvature, 
which is smooth, projects almost to the right-hand border of 
the pelvis. The small curvature can also be recognized and 
serves to identify the organ. The longitudinal muscular bands 
can also be felt. 

d. Impaction of the ileum. This usually occurs near the 
ileo cecal valve. The impacted intestine courses transversely 
from the left to the right side of the flank. It can be recog- 
nized by its sausage-like form which can be almost encircled 
by the hand. 

The following dislocations or displacements of the intes- 
tine can be diagnosed : 

a. Incarceration in inguinal canal; most frequently ob- 
served in stallions. The intestine can be felt about two or 
three inches in front of the pubic bone and four or five inches 
to the right or left of the median line where it seems to be 
firmly attached. A pull exerted at this point causes the ani- 
mal to evince signs of pain. Simultaneous examination of the 
scrotum (external) clinches the diagnosis. 



I 

I 

152 CLINICAL DIAGNOSTICS. 

b. Peritoneal hernia or so-called gut tie of the ox. A 
loop or knuckle of intestine can be felt at the anterior margin 
of the ileum, retained between the latter and the vestige of the 
spermatic cord. The doughy painful swelling, held in posi- 
tion by the tense cord which is situated anteriorly, are the 
characteristics of this condition. 

c. Invagination of the small intestine in cattle. This 
condition is recognized by the presence of a firm but elastic 
sausage-like mass in the lumen of the intestine, terminating 
abruptly posteriorly but insensibly anteriorly where food 
masses have accumulated. The length of this mass varies 
with the extent of the invagination. 

d. Torsion of the left layers of the colon in the horse. 
In this condition the tense mesentery can be felt coursing 
downward and to the left immediately in front of the entrance 
to the pelvis and just below the 4th lumbar vertebra. A pull 
exerted on the mesentery produces symptoms of pain. A sec- 
ond tense strand can be felt in the umbilical region (a longi- 
tudinal band of the inferior layer of the colon which courses 
from left to right). The pelvic flexure has shifted from its 
normal position. 

II. Enteroliths (stones and concretions in the in- 
testines) can be detected only when the intestines are compara- 
tively empty. The presence of large masses of food interferes 
with their recognition. It is best, therefore, when these are 
suspected, to free the intestines of their contents with a purge 
before proceeding with the examination. 

III. Tumors and tuberculous tumefactions of the 
lymphatics can be recognized only when they have a certain 
size, e. g., that of a hazelnut, and here too a purge must be 
given to remove solid fecal masses before exploration begins, 
otherwise mistakes are easily made. 

Percussion of the abdomen. Topographical anatomy. 
The position of the various portions of the intestinal tract 
varies considerable according to their degree of fullness ; we 



DIGESTIVE APPARATUS. 153 

can, therefore, not define the outlines of these organs with 
any degree of exactness in the living animal. In a general 
way, however, these outlines may be defined as follows : 

The right portions of the colon and the cecum occupy the 
right side of the abdominal cavity. We may be aided in de- 
fining the position of the various portions of the intestinal 
tract by drawing a line along the abdominal border of the 
area of percussion for the lung, and a second line along the 
course of the last rib and extending over the cartilages of the 
floating ribs; between these two draw a third (horizontal) line 
at the middle of the body of the animal. This outlines three 
areas on the right side of the abdomen. The anterior (lower) 
area is occupied, in the main, by the right upper portion of the 
colon, which occupies a position just behind the diaphragm. 
The ventral portion of the colon lies opposite the cartilages of 
the false ribs, in the region of the 8th to the 17th ribs, about 
half of its volume being situated above and the other half 
below the cartilages. 

The cecum occupies the whole of the third or posterior 
area as well as the upper anterior area as far as the 14th rib. 
The small intestines and the floating colon occupy a position 
behind the cecum beginning at a vertical line dropped from 
the external angle of the ilium. 

On the left side (Fig. 32, p. ) (in the horse) the 

small intestine and the floating colon occupy the region of 
the upper two areas while the third, or lower, area is occupied 
by the left portion of the colon, extending up to the ilium. The 
lower portion oft the colon occupies the greater area of the 
abdominal wall, the upper portion being placed more toward 
the median line of the abdomen, but approaching the abdominal 
wall as it courses forward, touching it through the medium of 
the diaphragm between the 1th and 11th ribs. 

By careful observation of their topographical relationship, 
and with the aid of percussion, we can readily determine the 



154 CLINICAL DIAGNOSTICS. 

character of the contents of the various sections of the intes- 
tinal tract. 

As a rule the stomach and intestines contain a moderate 
quantity of gases which distend their walls only slightly; 
hence percussion produces a tympanitic sound. In the paunch 
of cattle and the large intestine of the horse where food 
masses accumulate, the sound is at times dull tympanitic or 
even dull. (Topography of bowels at left side in the horse; 
see Fig. — ). 

Abnormal accumulations of food masses in the cecum 
and colon give rise to a dull sound and a sensation of resist- 
ance to the finger or pleximetric hammer at points on the ab- 
dominal wall opposite them. If the accumulation of gases 
causes the bowel walls to distend abnormally and become 
tense, a clear sound is produced, a sound resembling that pro- 
duced by the healthy lung, only clearer and louder because 
large air chambers are present. (In the lungs the air cham- 
bers are small). 

Bilateral dullness, limited above by a horizontal line, is 
observed when fluids collect in the abdomen (ascites). This is 
most frequent in the dog; raising the animal to a vertical 
position shifts the dull area accordingly. 

Auscultation of the abdomen. The observation of the 
various sounds produced by the moving along of the intestinal 
contents has for its objects the determination of the character 
of the movements of the bowels. The sounds are produced by 
the onward movement of the solid, liquid and gaseous contents 
of the bowels. The gases particularly produce distinctly audi- 
ble sounds. In the absence of intestinal contents sounds are 
not produced by peristaltic motion. 

The character of the sounds is determined by the consist- 
ency of the intestinal contents and by the quantity of gases 
present. Hence : the sounds of the small intestine are those 
of flowing liquid, gurgling, and splashing; the sounds of the 
large intestine rumbling, cooing, and tumbling. 



DIGESTIVE APPARATUS. 



155 



The intensity of the sounds corresponds to the intensity 
of the bowel movements, and we distinguish lively, weak, 
hardly audible, short and prolonged sounds or noise. 

None of the intestinal sounds are continuous, they are 
always interrupted by quiet intervals, but in healthy animals 



f 1 



/ 



\ 




Fig. 37. 

- - Dorsal and Ventral limits of area of percussion - - - Attachment of diaphragm 

to ribs. Coec. Coecum. v. c. Ventral fold of the colon. 

d. c. Dorsal fold of the colon. 

these intervals are never long. Practice in auscultation is of 
course necessary to enable us to judge correctly. 

In disease "quantitative as well as qualitative deviations 
from the normal occur. The sounds may be absent altogether 
in certain regions, e. g., the small intestine may have a lively 
peristaltic motion while the large intestine remains at rest. 
Intestinal sounds are reduced or diminished : 
1. In impaction, constipation and tympanitis, a paralytic 
condition resulting from overdistention and overloading 
(colic). 



156 CLINICAL DIAGNOSTICS. 

2. In spasmodic contraction of the small intestine in the 
course of spasmodic and rheumatic colic. 

3. In persistent diarrhea when the intestinal contents 
are scanty. 

4. In severe inflammatory conditions (because peristalsis 
is then more or less suspended and the intestinal contents are 
scanty) (enteritis, peritonitis). 

Very lively and loud intestinal sounds occur in all cases 
of slight stimulation, especially when the latter is produced by 
laxative food : green fodder, raw potatoes, wheat bran [clover 
hay, alfalfa, etc]. 

The sound of a drop of water falling onto a metal plate or 
pan is sometimes observed and belongs to a class by itself. 
It occurs when a loop of intestine is greatly distended and 
the fluid contents of the overlying intestines (small intestines) 
is forcibly flung against it and causes its walls to vibrate. The 
presence of this sound indicates that a loop of intestine is at 
rest and that it is distended with gas. 

VII. Intestinal Discharges or Evacuations. 

The quality and quantity of the discharges depend in the 
main on the kind and quantity of the food. The amount of 
water imbibed has little or no influence on the consistency of 
the discharges. The beginner must make an objective study 
of the character of the discharges of different animals on vari- 
ous foods, and in particular cases make comparisons with the 
discharges of other animals kept under the same conditions in 
the same stable. There are many diseases in which the char- 
acter of the bowel discharges is of very great importance. 

a. Defecation. The act of defecation is accompanied by an 
arching of the back with hind legs spread and slightly advanced; 
dogs assuming a crouching position. This is followed by a 
deep inspiration, fixing of the thoracic walls, contraction of the 
abdominal and intestinal muscles and relaxation of the sphinctei 
of the anus. 

Defecation is difficult when the feces are dry or hard 

(constipation). Continued rest after and during periods of 

heavy feeding may lead to an accumulation of bowel contents 



DIGESTIVE APPARATUS. 157 

or even to constipation. Voluntary defecation is almost im- 
possible when paralysis of the rectum exists, in such cases 
the agitation of the body during locomotion causes the feces 
to be passively discharged through the gaping anus. 

Involuntary evacuations of the bowels occur in cerebral 
spasms and in paralysis or relaxation of the anus. The latter 
is common in the course of severe diarrhoeas, here the semi- 
liquid feces flow down on the legs. 

Defecation is painful in the course of painful inflamma- 
tory conditions in the abdominal cavity (intestine, periton- 
eum), diaphragm or abdominal walls. These conditions all 
interfere with the normal contraction of the abdominal mus- 
cles during the act of defecation. In dogs foreign bodies 
(bones) in the intestines, and obstructions by agglutinated 
hair at the anus of long haired dogs, are particularly trouble- 
some. The patients groan, cry or howl during attempts at 
defecation ; they avoid the act as much as possible and thus 
bring on constipation. 

b. Frequency of defecation. Carnivora defecate once 
or twice daily, herbivora much more frequently ; horses 8-10 
times, cattle 12-18 times. These figures are increased by 
bodily exercise — particularly in horses that travel much. 

When the normal frequency of defecation is reduced, we 
say the animal is constipated. This is mostly the result of 
diminished peristaltic motion which is also attended with in- 
creased absorption of fluids. Constipation may result from 
impaction, occlusion, and dislocation of the intestine, first 
stages of intestinal catarrhs, inflammations, etc. Constipation 
is the principal symptom of colic, it may occur, however, 
without any other colic symptoms. In ruminants the ingesta 
are usually retained or retarded in the paunch and omasum, 
rarely in the intestines. 

The term diarrhea is applied to frequent and usually 
copious evacuations of liquid or semi-liquid feces ; it occurs 
in all irritated conditions of the intestinal mucous membrane 



158 CLINICAL DIAGNOSTICS. 

and is caused by feed, catarrh and inflammation. Psychic 
disturbances may lead to diarrhea by reflex action. 

c. Volume of feces. Here we must distinguish be- 
tween the amount passed at a single defecation and the total 
for a. day. Well fed horses (stable) pass 2 to 4 lbs. at each 
act, 20 to 30 lbs. per day. In acute and in chronic hydro- 
cephalus the volume of the evacuated masses as well as the 
intervals between evacuations is increased. The evacuations 
are increased in quantity in diarrhea following constipation, 
they are diminished after the use of evacuants and after 
[prolonged diarrhea] , during constipation and when animals 
are underfed. 

d. Consistency and form. Under normal and usual 
conditions horses' dung is evacuated in balls of a regular 
form, which on striking the ground usually break. In cattle 
the dung is voided in the form of a semi-solid mass (porridge), 
which flattens out upon striking the ground. Sheep and goats 
pass small firm balls resembling the fruit of the bay-berry. 
Swine and dogs pass feces somewhat more solid than those of 
cattle and frequently quite hard. In all animals the character 
of the food has a great influence on the appearance of the 
evacuations. In describing the dung of the horse we use the 
terms hard, firm, or loose balls, very moist balls, thick gruel- 
like mass, thin gruel-like mass, fluid, watery. 

Increased firmness or hardness of the feces is observed 
in all febrile diseases, in constipation, and in the first stages 
of intestinal catarrhs. In severe febrile diseases of cattle 
(malignant catarrhal fever) and in obstinate constipation the 
feces are dry, hard and resemble peat in appearance. 

Decreased firmness or abnormal softness of the feces 
occurs in all forms of diarrheas, intestinal catarrh, inflamma- 
tion (mycotic and septic), dysentery of calves [hog cholera], 
influenza of the horse, severe tubercular affections of the 
mesenteric lymph glands. 



DIGESTIVE APPARATUS. 159 

e. The color of the feces is due to admixtures of bile, 
coloring- matter in the food (chlorophyll in herbivora, haem- 
aglobin in carnivora) and secretions. An admixture of frag- 
ments of bone, in dogs, produces a light gray color. An 
exclusive milk diet produces yellow feces (bile); green fod- 
der produces a greenish hue ; oats, straw and timothy hay 
produce a yellowish brown color; corn, beans, rye (especially 
when coarsely ground) produce a gray or yellowish gray 
color. In cattle the diet is much more varied than in the 
horse, consequently it is difficult to determine a normal color. 
It varies from a distinct green (in pastured animals) to lighter 
and darker shades of endless variety. Concentrated foods 
(Kraftf utter) tend to produce a more grayish color. 

The following morbid changes may be observed: 

The longer the ingesta 'are retained in the intestine the 
darker they become. After continued constipation the feces 
of horses and cattle assume a blackish brown, peat-like color. 

A decreased admixture of bile (icterus) produces a gray, 
or light gray color resembling clay. Admixtures of blood 
produce a red, brownish red or chocolate color, sometimes 
almost black. A thorough admixture of the blood with the 
evacuated contents points to the occurrence of a hemorrhage 
in the anterior portions of the intestinal tract (hemorrhagic 
enteritis, dysentery, etc.). If the hemorrhage occurred in 
the rectum the blood adheres in the form of streaks or clots. 

Discolorations are produced by catarrhal and inflam- 
matory affections. In dysentery of calves the feces are gray 
or grayish white. Some medicines produce specific colora- 
tions of the feces : iron produces a black, calomel a green 
color. 

f. Covering of the feces. In herbivora the feces arc 
covered with a thin pellicle of mucus which gives them a 
shiny appearance. This coating of mucus increases or de- 
creases in thickness as the time during which the feces are 
retained in the intestine is increased or decreased. In intes- 



160 



CLINICAL DIAGNOSTICS. 



tinal diseases attended with extensive exudation from the 
mucous membrane the feces are not only coated with mucus 
but are mixed with it. This mucus may be glossy, colorless, 
yellowish (bile) or gray (epithelial cells and white blood 
corpuscles). Flaky or fenestrated coagulations on the surface 
of feces have their origin in the rectal mucous membrane 
(proctitis). 

g. Odor of the feces. This varies with every species 
according to the food. Horse dung can hardly be said to 






2 i 




Fig. 38 
Eggs of Ascaris megalocephala in dung of horse. Globular in form, diameter 0.1 mm, 

double contour. 



have an offensive or repulsive odor, the dung of the ox has 
an odor peculiar to itself, and the feces of carnivora stink. 
Horse dung has a sour odor in digestive disorders when con- 
centrated food was given in abundance. The feces of her- 
bivora stink or have a foul odor when putrefactive processes 
go on in the diseased digestive tract. If albuminous exudates 
(blocd) are present under these conditions the odor is car- 
rion-like (hemorrhagic enteritis, distemper of dogs). 



DIGESTIVE APPARATUS. 161 

h. The chemical reaction of the feces has no particular 
diagnostic value. Horse dung, as a rule, has an acid reaction, 
a result of the decomposition processes going on in the large 
intestine. In digestive disorders and intestinal catarrhs the 
acidity is often increased. 

i. Composition of the feces. The composition of the 
feces as far as food particles and foreign substances are con- 
cerned demands careful consideration. In the first place the 
size of the undigested food particles must he considered, this 
indicates the degree of mastication or rumination to whir' 



f i 









Fig. 39. 
Eggs of Distomum hepaticum in dung of sheep. 

they were subjected. In cattle the feces should consist of a 
homogeneous mass; coarse particles of food always indicate 
insufficient or faulty rumination: overloading of paunch, 
paralysis or inactivity resulting from inflammatory affections 
are the cause of the latter. In horses, on the other hand, 
coarse undigested particles of food occur normally in the 
dung, and faulty mastication is not indicated unless the coarse 



162 CLINICAL DIAGNOSTICS. 

particles are very numerous and whole or nearly whole grains 
of corn, etc., and bits of straw or hay can be recognized. 
The cause of the presence of coarse particles of food consists 
either in greedy feeding or in defective molar teeth. The 
degree of the defect bears a direct relation to the degree of 
coarseness of the food particles. 

Foreign b o d i e s in the feces of horses usually con- 
sist of sand, and in sheep we find wool. 

Inflammatory products consist of mucus, 
' 1 ood, pus, croupous membranes; in chronic intestinal catarrh 
c ' cattle we often find small clots of blood. 

In cattle and calves suffering with catarrhs or other in- 
flammatory conditions of the digestive tract the soft feces fre- 
quently contain numerous gas bubbles ; these are due to gas- 
producing putrefactive organisms which are particularly active 
in concentrated foods that pass rapidly along the digestive 
tract. 

Any parasites of the gastro-intestinal tract may occa- 
sionally be met with in the feces, either entire (Ascarides, 
Oxyuris) or in segments (proglottides of tapeworms) ; some- 
times the eggs only are present (Distoma in sheep and cattle). 
When Distoma are suspected a microscopical examination of 
the feces should be made. The eggs of these parasites are 
yellowish brown oval bodies or capsules provided with a lid, 
(0.15mm long, 0.1mm diameter). 

The most common parasites of the digestive tract are as 
follows : 

Horse: Gastrophilus equi and hemorrhoidalis, Ascaris 
megalocephala, Strongylus armatus [tetracanthus] , Tenia 
mamillana, perfoliata, and plicata. 

Cattle: Amphistomum conicum, Ascaris lumbricoides, 
Strongylus radiatus and ventricosus. Tenia denticulata and 
expansa, Tricocephalus affinis, Strongylus inflatus. In the 
bile ducts : Distomum hepaticum and lanceolatum. 

Sheep: Amphistomum conicum, Strpngylus contortus, 



DIGESTIVE APPARATUS. 163 

hypostomus, filicollis and ceriums, Tenia expansa, Tricho- 
cephalus affinis, and [Tenia fimbriata]. In the bile ducts: 
Distomum hepaticum and lanceolatum, and [Tenia fimbriata]. 

Goat: Strongylus contortus, hypostomus, filicollis and 
venulosus, Trichocephalus affinis, Tenia expansa. 

Pig: Spiroptera strongylina. Trichina spiralis. Ascaris 
lumbricoides, Echynorynchus gigas, Strongylus dentatus, Tri- 
cocephalus dispar. In the liver: Distomum hepaticum and 
lanceolatum. 

Dog: Tenia echinococcus, cenurus, marginata, serrata. 
cucumerina, Bothriocephalus cordatus and latus, Ascaris mvs- 
tax, Dochmius trigonocephalus, Trichocephalus depressiuscu- 
lus. 

The discharge of intestinal gases occurs only in horses 
and dogs ; corn and green feed produce these gases in large 
quantities. In old cows, with chronic affections of the rec- 
tum or undue laxness of the sphincter ani, air is often sucked 
in during the act of expiration and expelled again at inspira- 
tion, thus producing a sound as though intestinal gases were 
fjeing discharged. 

Addendum. An examination of the liver and spleen of 
domesticated animals is usually impracticable and in fact of 
little importance because primary diseases of these organs are 
rare. An enlarged liver in the dog can be felt in the region 
of the last rib. in the large animals palpation of the liver per 
rectum may, in rare instances, give valuable information. 
When greatly enlarged the spleen in the horse and the liver 
in the ox can thus be felt and tubercles, echinococci and 
tumors recognized. 

Diseases of the Digestive Apparatus, 
a. Mouth, Pharynx and Esophagus. 

Stomatitis. Here the morbid changes can be directly ob- 
served; three forms: Stomatitis catarrhalis, st. vesicularis, st. 
ulcerosa. 

Ptyalism. A continued discharge of large quantities of saliva 
without any assignable cause. 



164 CLINICAL DIAGNOSTICS. 

Pharyngitis, Angina pharyngea. More or less fever accord- 
ing to the character of the inflammation. Head held up, neck 
stiff. Appetite present but mastication and especially deglutition 
impaired. Food and particularly water ejected through the nose. 
Accumulation of saliva and food in the mouth, salivation; foreign 
bodies (food) in larynx, and cough. More or less symptoms of 
laryngitis, in serious cases dyspnea as a result of swelling of 
laryngeal mucous membrane. 

Paralysis of esophagus and pharynx. Dysphagia paralytica, 
difficult deglutition and absence of inflammatory symptoms. 

Foreign bodies in esophagus. Most frequent in cattle (but 
also observed in horses); salivation, inability to swallow, choking, 
flow of saliva from nose; tympanitis in cattle. Foreign body in 
cervical portion of esophagus can be seen or felt. 

Esophageal stenoses and diverticula usually develop slowly 
and gradually. Symptoms: Sudden interruption in feeding, im- 
paction of esophagus with food; regurgitation, choking. Dis- 
charged masses are foamy but not sour. 

Diseases of the teeth in animals produce trouble in feeding. 
Animals begin eating with apparent appetite, but soon stop or 
continue with diminished interest, masticate slowly and carefully, 
smack their lips, pause, salivate, reject partially masticated food, 
swallow their grain whole, masticate roughage poorly, don't eat 
a full feed, feces contain large particles of food, sometimes there 
is a tendency to diarrhea. The following conditons of the teeth 
are of clinical importance, viz., sharp teeth, very oblique grinding 
surfaces (shear-jaws), an undulating or irregular set of teeth, pro- 
jecting or depressed teeth; caries of the teeth, tartar deposits; 
periostitis alveolaris, tooth fistulae, neoformations on the alveolar 
periosteum. 

b. Gastric and Intestinal Diseases of the Horse. 

Acute dyspepsia. Lack or loss of appetite, particularly for 
grain; animals lick cold objects. Thirst is increased, buccal mu- 
cous membrane dry, animals yawn frequently. 

Acute gastro-intestinal catarrh. Usually fever, animal is 
downcast, conjunctiva reddened, sometimes icteric. Appetite much 
impaired, frequent yawning, buccal mucous membrane reddened 
and clammy; feces at first dry, later diarrheic; urine acid, with- 
out sediment, contains much indican. 

Chronic dyspepsia. Chronically impaired appetite. Gastric 
disturbances. 

1. Simple chronic dyspepsia. Appetite for con- 
centrated food (grain) impaired, otherwise normal. 

2. Acid dyspepsia. Impaired appetite, but a craving 
for alkalies; licking whitewashed walls, nibbling at soiled litter. 

3. Nervous dyspepsia. This occurs in easily excitable 
horses and consists in temporary disturbances of appetite after 
excitement. 

Chronic gastro-intestinal catarrh. Gastro-enteritis catarrhalis 
chronica. Soft consistency of feces, or hard and soft alternately,. 



DIGESTIVE APPARATUS. 165 

containing mucus, appetite impaired. Mucous membranes muddy- 
red. Urine acid. 

Colic of horses. The term colic is applied in a general way 
to pathological conditions of the gastro-intestinal tract that cause 
horses to manifest symptoms of pain. As a rule they are caused 
by interrupted progress of the intestinal contents. The most im- 
portant symptoms are those indicating pain, efforts to uri- 
nate and defecate, diminished peristalsis and retarded defeca- 
tion. Sometimes impaction or torsion of the bowels can be rec- 
ognized as the causes (rectal examination). Before making a 
prognosis note carefully the condition of the conjunctiva and the 
pulse. 

Gastro-enteritis. Inflammation of the stomach 
and intestine. High fever, great depression of the sensorium, 
mucous membranes muddy red; pulse very rapid, respiration in- 
creased. Complete loss of appetite, buccal mucous membrane hot, 
feces as in diarrhea, foul odor, and bloody. Rising is painful. 
Forms : Gastro-enteritis rheumatica, toxica, cruposa, mycotica, 
parasitica. "" 

c. 'Gastric and Intestinal Diseases of Cattle. 

Acute tympanitis. Hoven, bloat. Rapid tympanitic disten- 
tion of the paunch, food and drink are refused, defecation retard- 
ed. Increased and labored breathing, animals are anxious and 
restless. 

Acute dyspepsia. Acute derangement of activity of stomach. 
No fever, heed is absolutely refused, rumination suspended, belch- 
ing, abdomen full, paunch contents firm, paunch movements slight, 
auscultation reveals sounds of bursting bubbles, feces dry, later on 
containing coarse food particles. 

Acute gastro-intestinal catarrh. Fever, conjunctiva reddened, 
pulse frequent, appetite often entirely wanting, flanks sunk in, 
paunch movements incomplete. Milk secretion suddenly retarded. 

Chronic gastro-intestinal catarrh. Gradual development and 
frequent change of symptoms. Appetite reduced, bloating follows 
a heavy feed, rumination interrupted. Defecation usually retard- 
ed, feces mixed with mucus, now and then diarrhea. If disease 
is severe diarrhea is continuous. Animal weak, falls off in flesh. 

Chronic tympanitis, chronic indigestion. Periodi- 
cally recurring attacks of slight bloating of pauncb that continue 
for some time. Rumination and paunch movements retarded. 
Coarse food particles in feces. 

Dislocation of bcwel. 1. Invagination (telescoping) of 
intestine. Occur- suddenly and without external cause. Animals 
are restless, lie down, set up again, kick their bellies, groan. These 
symptoms attended with fever. Feeding and rumination cease, 
obstinate constipation, discharges of mucus and blood. Pains 
soon grow less but fever increases. Palpation per rectum usually 
enables us to feel the invaginated gut. 

2. Peritoneal hernia or gut tie in the ox. Symp- 
toms same as in invagination, in addition an abducted position of 



166 CLINICAL DIAGNOSTICS. 

hind leg which is also extended back. Sacral region depressed. 
Palpation per rectum reveals presence, at anterior border of ileum, 
of painful doughy swelling, held in place by vestige of spermatic 
cord. 

Licking disease of cattle and wool eating of sheep are pecu- 
liar chronic affections; afflicted animals have a habit of lickings 
nibbling, or even swallowing objects of a various nature, including 
indigestible and often loathsome and disgusting substances. At 
the same time there is loss of appetite and emaciation. 

d. Gastro-Intestinal Diseases of the Dog. 

Acute Gastric Catarrh. Frequently febrile. Usually begins 
with vomiting of food masses, followed by vomiting of mucus. 
Loss of appetite, increased thirst, depression, evacuation of bow- 
els retarded, symptoms of pain upon pressure over the region of 
the stomach. 

Acute Intestinal Catarrh. Usually febrile and attended with 
diarrhea; feces of bad odor and frequently fermenting. Icterus 
and bile pigments in urine common symptoms. 

Constipation. Cause, as a rule, in the rectum. Defecation 
retarded, animals make frequent unsuccessful attempts, tail 
elevated. Abdomen frequently bloated; palpation reveals impac- 
tion of rectum, painful upon pressure. Digital exploration reveal- 
ing presence of hard fecal masses. 

Foreign Bodies in the Intestines. Frequently situated anterior 
to the ileo-cecal valve. Vomiting, complete loss of appetite, ab- 
sence of fever. Object can usually be located by careful palpation 
of pelvic region. Caution: Do not confuse with kidneys, especially 
in cat. 

e. Diseases of the Peritoneum. 

Acute Peritonitis. Usually secondary, following rupture or 
perforation of intestine, perforation of abscesses or extension of 
inflammation of adjacent organs; symptoms therefore not charac- 
teristic. Symptoms of colic, stiff gait, looking at the flank, groan- 
ing. Marked depression, staring look, moderate to high fever. Mu- 
cous membranes reddened. Pulse, rapid, small, soft. Respiration 
short, superficial, frequent. \ T o appetite for food or water, ab- 
dominal muscles contracted, painful; peristalsis suspended, some- 
times diarrhea as death approaches. Defecation and urination 
retarded, painful. Death often following after a few hours. 

Chronic Peritonitis. In horses, symptoms of colic and fever, 
irregular appetite and emaciation. In cattle and dogs colic symp- 
toms absent, but pain upon palpation, presence of exudates. 

Traumatic Inflammation of Stomach and Diaphragm in Cattle. 
Indigestion of sudden appearance without apparent cause. Ani- 
mals show disinclination to lie down, stand in stiff position, are 
very careful when rising and don't stretch. Expression of eyes 
indicating pain. Surface temperature irregularly distributed, bod- 



URINARY APPARATUS. 167 

ily temperature elevated. Pulse accelerated and ha^d. Respira- 
tion rather retarded, groaning and manifestations of pain. No 
appetite for food or drink, rumination suspended. Pressure on the 
right side, sixth and seventh ribs, painful. Milk secretion de- 
creased. 

f. Infectious Diseases with Localization 
in the Digestive Tract. 

Rinderpest is a readily transmissible, acute infectious disease, 
of cattle. It usually takes a fatal course. Period of incubation 
6-7 days. High temperature is the first symptom. Eyelids swol- 
len, conjunctiva very red, respiration difficult, dirty yellowish nasal 
discharge, nasal mucous membrane reddened in spots, cough, 
moist rales, frequently interstitial pulmonary emphysema and cu- 
taneous emphysema; complete loss of appetite, feces fluid, discol- 
ored; secretion of milk suspended, great depression, and general 
weakness of the body. Dark red areas on mucous membranes 
which (spots) become coated with grayish white layers, when the 
latter drop off and leave ulcerous erosions. Most animals die on 
the fifth or sixth day. 

Stomatitis pustolosa contagiosa is an exanthema with a typical 
course. It occurs in the form of pustules, principally at the 
mouth, and is characterized by its mild course. Period of incu- 
bation 3-5 days. At first appearance of eruption there is fever, 
but this soon subsides. Horses refuse feed, they salivate, mouth 
painful to the touch. Within 2-3 days minute nodules or blisters 
appear on the mucous membrane; these are at first red, then gray 
or yellow, break open and form ulcers. Intermaxillary glands 
swollen, conjunctivitis, now and then ulcers on the outer part 
(skin) of the lips, forearm and body; healing requires 10 days to 
two weeks. 

g. Intoxications. 

Lupinosis is an intoxication disease affecting the body as a 
whole. It is caused by a poisonous principle (lupinotoxin) which 
occurs in lupines. Diminished appetite, increased temperature, 
icteric coloration of conjunctiva, general weakness, cerebral de- 
pression. Urine yellow, contains bile pigments and albumin. 

[Loco weed poisoning.* An intoxication disease affecting 
chiefly the nervous system. Effects not noticeable until a consid- 
erable quantity of the "loco weed" has been eaten. Gait slow and 
measured, eyes glassy and staring, vision interfered with, convul- 
tions when animal is excited, later on, general emaciation. Occurs 
in western States.] 

IX. Urinary Apparatus. 

In diagnosing diseases of the lungs percussion and aus- 
cultation of the chest is of fundamental importance. In dis- 
eases of the urinary apparatus we depend on the results of 

* U. S. Report. 



168 CLINICAL DIAGNOSTICS. 

physical and chemical examinations of the urine. Experience 
has taught us that affections of the kidneys and urinary tract 
are not as common in animals as they are in man and conse- 
quently urinary analyses hardly merit the same importance 
that is attached to them by physicians. Besides this the entire 
field of kidney pathology in animals has received so little at- 
tention from investigators that our lack of knowledge is often 
evident to the diagnostician. 

Results of a urine examination often enable us to diag- 
nose affections of other organs the abnormal products of 
which pass over into the urine. 

The collection of the urine from animals is 
always attended with difficulties, in practice it is often impos- 
sible. As a rule the urine is caught up in a vessel during the 
natural act of the animal. In horses a vessel can be secured 
to the sheath and the urine thus collected. In female animals 
the use of a disinfected catheter is permissible. 

In the course of the clinical examination we consider the 
urine first ; if the latter shows material changes we also 
examine the urinary organs. 

Accordingly we consider the following points and in the 
order given : 

I. Manner of Voiding the Urine. 

II. Examination of the Urine. 

A. Macroscopical examination. 

B. Chemical examination. 

C. Microscopical examination. 

III. Examination of the Urinary Organs. 

I. Manner of Voiding the Urine. 

In our domestic animals urinating is a reflex act inaugurated 
by the stimulus of the urine on the mucous membrane of the dis- 
tended bladder. As long as the distention of the bladder is below a 
certain point the reflex action of the sphincter vesicae which is 
also inaugurated by the pressure of the urine, supersedes that of 
the muscular coat, hence the one gives way to, or takes the place 
of, the other as occasion demands. 



URINARY APPARATUS. 169 

In adult male dogs only do we observe frequent and 
'voluntary urination. For this act they prefer places used for the 
same purpose by oilier dogs. Their choice places are trees, the 
corners of houses, etc. 

When urine is voided the bladder contracts and this is aided 
by the abdominal muscles. Every species of animal manifests 
peculiarities of its own in this act, but it is a rule that all animals 
stand while urinating. 

Horses (both sexes') urinate only while resting and cease feed- 
ing for the time; not infrequently they emit loud groans. 

Cows urinate similarly to mares, male cattle on the other 
hand urinate not only while feeding but also while walking; in 
fact, in these animals the act seems almost to be a passive one.' 

Old dogs and pigs (male) void the urine in an interrupted 
jerky stream. 

a. The frequency of urination depends on the amount of 
water imbibed, the amount of water lost by respiration, perspira- 
tion, and per intest'inl tract; accordingly it varies very consider- 
ably. Healthy horses ordinarily urinate 5-6 times a day. 

1. Abnormal frequency of urination occurs during in- 
creased secretion of urine (polyuria) in the course of dia- 
betes, and in chronic inflammation of the kidneys, temporarily 
in the crisis of severe diseases (contagious pleuropneumonia 
of horse). 

2. Urination is suppressed, when rupture of 
the bladder has occurred (urethral calculus) in oxen; to 
determine (in doubtful cases) whether or not an ox urinates 
a clean cloth is tied in front of the opening of the urethra. 

b. Abnormally frequent attempts to urinate, only 
slight quantities of urine being passed at each attempt, 
stranguria. The cause of this is an abnormal irritability of 
the mucous membrane of the bladder and urethra. Such 
conditions are most frequently observed in the course of 
colic in horses. where the distended intestines (impaction, con- 
stipation, tympanitis) exert a pressure on the bladder, or the 
sense of fulness of the abdomen causes the animals to make 
these attempts. Inflammatory conditions of the bladder 
(bladder diseases, stone and gravel, neoformations, poison- 
ing with irritating substances) or of the urethra (applica- 
tions of pepper) are much less common causes. Mares in 



170 CLINICAL DIAGNOSTICS. 

oestrum often show these symptoms at the same time re- 
peatedly protruding the clitoris. 

c. When urination is painful the term dysuria is ap- 
plied. The animals are restless, step to and fro, kick at 
their bellies, switch their tails, look back at the abdomen, 
groan, and void urine in drops or thin streams. The seat 
of the pain may be in the bladder or in the urethra (concre- 
ments, strictures, inflammations). Sometimes the pain is 
caused by abdominal pressure in peritonitis. 

d. Retention of urine (ischury) is attended with accu- 
mulation of urine in the bladder. It is observed: 

1. In obstruction of the urethra (concre- 
ments, swellings, strictures, tumors). In such cases the urine 
is voided in drops or thin streams, and frequently with symp- 
toms of pain. 

2. In paralysis of the bladder; frequently 
associated with paralysis of the rectum and of the tail. 

e. Inability to retain urine, incontinentia urinae, occurs 
as a result of paralysis or weakening of the sphincter of the 
bladder, or as a result of diminished sensitiveness of the 
urethral mucous membrane, thus suspending the reflex ex- 
citability of the sphincter. Most frequently observed in dogs 
in the course of distemper (spinal affection) but otherwise 
rare in animals. 

II. Examination of the Urine. 

A. Macroscopical Examination. 

a. The quantity of urine voided depends on the same 
conditions that regulate the frequency of voiding it : on the 
average horses secrete 4-5 liters, cattle G-12 and dogs %-l 
liter per day. As a rule we determine the quantity of urine 
voided daily by making an estimate. Collecting the urine for 
actual measurement is cumbersome and, besides, not exact. 

A decrease in the quantity of urine is observed in: 

Profuse sweating and diarrhea. 



URINARY APPARATUS. 



171 



Severe febrile diseases. 

Formation of large quantities of exudates in the pleural 
and peritoneal cavities. 

Weak heart and resulting diminished pressure. 

Acute and some forms of chronic nephritis. 

An increase in the quantity of urine occurs in: 

Diabetes insipidus [polyuria] (very marked) diabetes 
mellitus (which is rare), the daily average may be 40 liters. 

Most forms of chronic nephritis. 

During reabsoption of profuse exudates and in the criti- 
cal stage of severe infectious diseases. 

b. The color. The normal pigments in urine have not 
yet been thoroughly studied; although a number of them 
are known to exist, only one has been identified, viz. urobilin 
which is a product of bilirubin and is absorbed from the 
intestine. The color of normal urine is more or less yellow, 
increasing in darkness as the amount of urine decreases, and 
vice versa. In disease the color may become lighter or 
darker. We distinguish: yellow (pale yellow, light yellow, 
yellow), red (reddish yellow, yellowish red; red), and brown 
(brownish red, reddish brown, and blackish brown) urine. 
Other shades can also be recognized now and then. 

Pale, water-colored urine always occurs in polyuria 
(physiological or critical polyuria, diabetes). 

Red urine is produced by admixture of blood, hemaglo- 
bin or methemaglobin. The particular cause in each case 
must be determined with the aid of the microscope. 

Greenish yellow or brownish yellow urine or yellowish 
green foam is produced by bile-pigments. 

Dark colored urine (dark yellow or dark brown) is ob- 
served in all cases where the quantity has been reduced (con- 
centrated), but it may also be due to admixture of blood. 

Color due to medicines: carbolic acid, black: aloes and 
rhubarb, brownish red. 

c. Transparency of urine. Normal urine of the horse 



172 CLINICAL DIAGNOSTICS. 

is always turbid ; even the first few drops voided; toward 
the end it becomes even more so, frequently a light clay 
color. The turbidity is due to the presence of carbonates 
which precipitate in the bladder as the fluid becomes more 
or less condensed from reabsorption processes. When ex- 
posed tO* the air in a vessel the turbidity increases because 
the soluble acid calcium carbonate (C0 3 H) 2 Ca after giving 
off C0 2 HoO is converted into insoluble calcium carbonate 
C0 3 Ca. This conversion occurs most rapidly at the surface 
of the liquid, causing the formation of a thin fragile mem- 
brane at that place (crystals of calcium carbonate). Small 
granules of lime also precipitate and constitute a part of the 
sediment. Not infrequently these lime granules are im- 
bedded in cylindrical masses of mucus that were molded in 
the uriniferous tubules. This normal turbid urine has an 
alkaline reaction. 

Clear urine of the horse is always abnormal 
and usuallv has an acid reaction ; upon cooling, however, it 
may become turbid. The turbidities consist of precipitated 
phosphates, oxalate of lime, and crystals of gypsum and uric 
acid salts ; these dissolve upon heating the .fluid. These salts 
can be recognized by means of a microscopical examination. 

Abnormal turbidity may be due to the presence 
of organized elements (cells) ; recognized by means of mic- 
roscopical examination. 

In the ox, sheep and goat the normal urine is 
clear when voided but becomes turbid on standing; precipita- 
tion of monocarbonates. 

The urine of the dog is clear in health, becom- 
ing slightly turbid after standing; due to precipitation of 
uric acid salts. 

d. Consistency of urine. Normal urine of the horse 
is a rather thickish, slimy, viscous fluid ; the viscosity being 
due to an admixture of mucine which occurs in the bladder. 
Besides this the cast off epithelial cells undergo a process 



URINARY APPARATUS. 173 

of swelling and thus increase the consistency of the urine. 
Acid horse urine is always less viscid than such as gives 
an alkaline reaction because the epithelial cells swell more 
in the former. 

All other domestic animals excrete a more watery urine. 

e. The specific gravity of urine is determined with an 
araeometer, also called urinometer when specially con- 
structed for this specific purpose. 

The specific gravity for the 

horse is 1020—1050, average 1040, 
ox " 1025—1045, " 1030, 

dog " 1020—1060, " 104 0. 

The specific gravity varies inversely with the quantity. 
Aside from this an a b n o r m a 1 1 y 1 o w specific gravity is 
observed in diabetes insipidus (1001-1010) and in contracted 
kidney. 

An abnormally high specific gravity is observed in 
all cases where the amount of urine secreted is below the 
normal (fever) and in acute nephritis. High specific 
gravity and increased quantity is observed 
only in diabetes mellitus. 

B. Chemical Examination of the Urine. 

a. The reaction of the urine of healthy animals de- 
pends on the kind of food: herbivora (horse, ox, sheep, goat) 
secrete an alkaline urine, carnivora (dog, cat) secrete acid 
urine. In omnivora the reaction depends altogether on the 
food. 

In herbivora the alkaline reaction is due to the 
presence of acid bicarbonate of lime CO..H — Ca — CO a H. 
The organic acid salts of lime which are contained in the food 
contain the acid radicles of malic, tartaric, succinic and lactic 
acids. These latter, upon being absorbed into the blood, be- 
come oxydized into acid carbonates which have an alkaline 
reaction. 

In carnivora acid phosphates are the cause of the 



174 CLINICAL DIAGNOSTICS. 

acid reaction; P0 4 H L ,Xa and P0 4 HXa ; these come from 
the animal diet. Starving herbivora (hence such as live on 
their own flesh) have an acid urine. 

Except in cases like the one just mentioned an acid reac- 
tion of the urine of herbivora is always abnormal. It occurs 
when the contents of the small intestine have an acid reaction 
— intestinal catarrh. When the contents of the small intes- 
tine have a normal (alkaline) reaction the acid phosphates 
in the food are not absorbed, and consequently do not enter 
the circulation, but when the reaction is acid the opposite 
takes place, the acid phosphates are absorbed and excreted 
bv the kidneys, but the organic acid salts are not absorbed. 
An acid reaction, therefore, depends on the presence of acid 
phosphates and, in case of herbivora with good appetite, 
points to the existence of intestinal catarrh. 

Abnormal alkaline reaction of the urine of 
herbivora and carnivora occurs in the course of fermenta- 
tions in the bladder (catarrh) and is produced by ammonia, 
which is a product of fermented urea: CO(NH 2 ) 2 + 
2HX) = C0 3 (NH 4 ) 2 = 2NH, -f- C0 2 + ~ H,0. 
This ammoniacal fermentation can be recognized by its odor. 
A glass rod dipped in hydrochloric acid and held above 
the surface of the urine causes fumes to appear: NH 4 C1 
= ammonium chloride. 

b. Albumin. Serumalbumin associated with serum- 
globulin is the usual form in which albumen occurs in urine. 
Albumoses, i. e., albuminous bodies not precipitated by boil- 
ing, may be found alone or in connection with the above, but 
are of rarer occurrence. (Pepton, propepton, hemialbumose). 
Occasionally hemoglobin and methemoglobin are found. 

These three groups are alone of practical importance. 

I. Albuminuria. Albumin never appears in normal 
urine in appreciable quantity ; its presence must therefore 
always be looked upon as an indication of disease. 

As a rule the albumin is secreted with the urine, in the 



URINARY APPARATUS. 175 

kidneys (renal albuminuria), in rare cases its presence is 
due to admixture of blood or pathological products (acci- 
dental albuminuria ) . 

The fact that healthy urine contains no albumin in ap- 
preciable amount is explained by the impermeability of the 
renal epithelium to albumin and by the limited normal blood 
pressure. A change from the normal, such as may be 
brought about by pathological conditions of the blood or in- 
creased bodily temperature, may cause the appearance of 
albumin in the urine. 

Hence, renal albuminuria can occur : 

1. As a result of changes in the renal tis- 
sues due to inflammatory or degeneration processes ; here 
we find not only albumin present, but the quantity of urine 
may be increased by the addition of albuminous exudate. 

2. In lowering of arterial pressure; the 
lower the pressure the easier can a diffusion of albuminous 
substances take place. Pressure is lowered in weak heart or 
in venous congestion (organic heart disease, emphysema). 
Both conditions, after existing for some time, in addition 
produce changes in the renal epithelium. 

3. In fever albuminuria is always present. Several 
factors are active here. The lowered pressure may alone 
account for it ; the elevated temperature facilitates the pro- 
cess ; continued fever produces changes in the renal epithe- 
lium. In case of severe infectious fevers a direct injury to 
the renal parenchyma probably occurs because in such cases 
the urine is very rich in albumin. 

4. Mere changes in the normal composi- 
tion of the blood, in the absence of any change of 
blood pressure or change of structure of the kidneys, may 
bring about albuminuria (leucemia). 

From what has been stated we can readily 
see that the mere presence of albuminuria 



176 



CLINICAL DIAGNOSTICS. 



Fig. 40. 



km 



does not necessarily indicate an affection of the 
kidneys. 

Accidental albuminuria is rare and 
of little importance. We assume that the albu- 
minuria is accidental when the filtrate contains 
large quantities of blood and pus corpuscles and 
epithelial cells and only a moderate quantity of 
albumin. In that case the proportionately small 
amount of albumin is supposed to result from par- 
tial solution of the cellular elements. 

Chemical determination of albuminuria. For 
this use freshly voided urine ; if not clear, filter. 

1. Koch's test. Fill test tube to J4 its height 
with urine — if alkaline add a drop of acetic acid — boil 
and then add 1-10 its volume of dilute nitric acid (sp. 
gr. 1.18); a permanent precipitate indicates albumin. 
If a precipitate or turbidity produced by boiling dis- 
appears on addition of nitric acid it indicates phosphate 
of lime. 

2. Heller's test. The cold, filtered (and, if 
necessary, acidulated) urine is carefully poured on con- 
centrated nitric acid, so as to form a layer on the same. 
If albumin is present a white or cloudy ring is formed 
in the test tube where the urine comes in contact with 
the nitric acid. 

3. Acetic acid ferro-cyan i d e of 
potash test. To the filtered urine add a quan- 
tity of acetic acid and then a few drops of a 5% solu- 
tion of potassium ferrocyanide; the presence of albumin produces 
a white precipitate. 

If the addition, of acetic acid produces cloudiness mucin is 
present; in this case filter the urine. The mucin may also be pre- 
cipitated with acetate of lead before making the test. 

4. In case only a limited quantity of urine is obtainable, the 
following method is recommended: Heat distilled water to boil- 
ing point in a test tube, add the urine drop by drop. If albumin 
is present the drops become turbid in the water, and by 
continuing the addition of the urine, the water also becomes 
turbid. 

The methods here given suffice for the clinical demonstration 
of albumin. For a quantitative determination of the albumin 
preserve the tubes containing the precipitate and thus the sedi- 
ment, which consists of albumin, may be compared from day to 
day. For this purpose Esbach's albuminimeter is both simple 
and practical. See fig. 40. [Similar tubes can be obtained in 



Esba h's 
Albumini- 
meter. 



URINARY APPARATUS. 177 

the United States.] It is used as follows: Fill the tuhe with 
urine to the mark U (urine), then add reagents sufficient to fill 
the tube up to the mark R (reagents) as follows: 

citric acid, 2.0 cc, 

picro-nitric acid 1.0 cc, 

distilled water 100.0 cc; 
put on a stopper, shake well, and let stand 24 hours. The sedi- 
ment which consists of albumin can then be read off in fractions 
of 1-10%. This instrument gives good results providing the 
amount of albumin present does not much exceed 0.2%; in that 
case dilute before testing the urine, say to 50% or 25%, by adding 
one or three volumes of water respectively: the result must then 
be multiplied by 2 or 4 according to the dilution. 

A 1 b u m i n u r i a occurs : 

In all febrile diseases, especially in acute infectious dis- 
eases ; contagious pleuro-pneumonia of the horse and in in- 
fluenza. 

In acute and chronic affections of the kidneys. 

In venous congestion, hence in organic heart disease, 
emphysema and in the various forms of heaves 

In blood diseases ; leukaemia, anaemia. 

In nervous affections, epilepsy, eclampsia. 

II. Albumosuria. Examinations for albumoses have 
only recently become of importance, since simpler methods 
have been discovered. The occurrence of albumoses de- 
pends upon entirely different conditions than those which 
produce albuminuria. Albumosuria is not caused by in- 
flammation of the kidneys, by disorders of circulation nor by 
anemia. Changes in the composition of the blood play 
the chief role here. Albumoses cannot be determined by 
boiling the fluid containing them, nor by the addition of 
acids. It is only in the absence of other albuminous sub- 
stances (albumin, globulin, mucin) and various other pig- 
ments that their presence can be determined. 

Chemical determination of albumoses. Take 10 cc of unfil 1 - 
tered urine and acidulate with a 20% solution of acetic acid. If 
the reaction of the urine is acid, two or three drops will suffice, 
if alkaline, it requires more. Add 5cc of a 20% solution of ace- 
tate of lead, boil and filter. Add to the filtrate a solution of caus- 
tic potash until precipitates no longer occur; it may require l">cc 
or more of the potash solution to bring about this result; it is im- 



178 CLINICAL DIAGNOSTICS. 

portant to use sufficient potash solution as otherwise the reaction 
will not occur. The filtrate is now subjected to the biuret reac- 
tion: Add five or six drops of a solution of sodium hydrate, then 
add, carefully, one or two, or at the most, three, drops of a 10% 
solution of sulphate of copper. If albumoses are present a red- 
dish violet color is produced. This test is the simplest and most 
reliable for testing the urine of animals, since all substances that 
might otherwise have interfered with the test are removed. 

Schulz's method is very simple and reliable. Filter the 
urine and add several volumnes of alcohol to precipitate all of 
the albuminous substances. Filter again and treat the residue 
(precipitate) with a stream of water; this dissolves the albumo- 
ses, if present, and then the biuret-reaction is applied to this solu- 
tion. 

Albumoses occur in the urine in the course of abscess 
formation in the internal organs of the body (Strangles), and 
as a result of the absorption of extensive exudates in the course 
of influenza of horses, peritonitis and pleuritis. 

The determination of albumoses is of clinical importance 
for the determination. of suspected abscess formation in inter- 
nal organs. 

III. Hemaglobinuria. The fact that urine con- 
tains blood may often be recognized by its color alone ; light 
red urine, resembling meat water, (oxyhemoglobin) is rare. 
As a rule it has a muddy brownish red color (methemo- 
globin). A diagnosis cannot be based upon the color alone, 
a chemical and microscopical examination is necessary. 

Chemical determination. Add caustic potash or soda until 
the urine is distinctly alkaline, then boil as in albumin test. This 
converts the hemoglobin into hematin, it is precipitated with the 
earthy salts and gives them a reddish brown color. 

The difference between oxyhemoglobin and methemoglobin 
must be determined with the spectroscope. Oxyhemoglobin gives 
two absorption bands between D and E, methemoglobin gives 
one between C and D. 

The presence of hemoglobin may be due to admixture 
of blood as such (hematuria) or to hemoglobin alone (hemo- 
globinuria). 

Hematuria is recognized by microscopic examination 
of the sediment and the detection of blood corpuscles. The 
admixture of blood can occur in the kidney, the pelvis of 
the kidney, the bladder or the urethra. It occurs most fre- 



URINARY APPARATUS. 179 

quently in red water, acute nephritis, renal calculi, hemor- 
rhagic infarction of the kidney, pyelonephritis, acute cystitis, 
cystic calculi. 

Hemoglobinuria consists in the presence of hemoglobin 
(without the blood corpuscles) in the urine. The coloring 
matter is derived either from the blood or the muscles. Ac- 
cordingly we distinguish : 

a. Hematogenic or toxemic hemoglobinuria in red- 
water of cattle and in Texas fever, also in bad cases of pois- 
oning which cause decomposition of the red corpuscles, in 
extensive burns and in the course of severe infectious dis- 
eases. 

b. Myogenic or rheumatic hemoglobinuria in azoturia. 

c. Indican — indoxyl sulphate of potash C s H ti N K 
S 4 , occurs in all urine in moderate amount. It is de- 
rived from the indol C 8 H 7 N formed in the alimentary canal 
during putrefaction of albumin ; indol is oxydized into in- 
doxyl C 8 H 6 N O H and then combines with sulphate of 
potash to form indoxyl sulphate of potash — indican. The 
urine of the horse contains on an average, 184 nig. per liter. 

If rapid putrefaction of albuminous substances takes 
place in the alimentary canal the amount of indican is in- 
creased ; this is particularly the case in digestive disorders 
accompanied with diminished peristalsis, digestion and ab- 
sorption. Constipation of the ileum produces the largest 
amount of indican ; impaction of the colon on the other hand. 
is attended with much less indican formation. 

Diarrhea is attended with diminished indican formation. 

Test for Indican. Mix equal parts of urine and 
pure nitric acid in a test tube, shake well; then add, drop by drop, 
followed by repeated shaking, a fresh solution of chloride of lime. 
this causes the formation and precipitation of indigo, recognized 
by its blue color. The addition of chloroform followed by thor- 
ough agitation, dissolves the indigo and the resultant blue solution 
settles at the bottom of the test tube. 



180 CLINICAL DIAGNOSTICS. 

Quantitative Determination, according to 
Bauer. Take 20 cc of the urine, slightly acidulated with acetic 
acid, precipitate with two, or if necessary, with four cc of a 20% 
solution of acetate of lead, filter through a dry filter paper; take 
11 or 12 cc (enough to represent 10 cc of urine) of the filtrate 
and add an equal volume of Obermayer's Reagent (solution of 
chloride of iron in fuming hydrochloric acid 2:1000). Upon the 
appearance of a dark coloration, always occurring in urine con- 
taining indican in any quantity, allow the solution to stand a few 
minutes, add 20 cc of chloroform and shake thoroughly for about 
fifteen seconds. After a short time, when the chloroform has 
settled to the bottom of the test tube as a clear blue solution, pour 
a portion of the chloroform into an absorption-test-vessel of 4mm 
depth, place the vessel upon a piece of paper adjacent to the colors 
in the table, and by comparison determine which solution has a 
corresponding amount of indican. If the color corresponds in 
shade to that given in plate I, the urine contains 50 mg of indigo 
blue per liter, if it corresponds to the shade indicated in plate II, 
it contains 100 mg per liter, etc. If the shade is darker than 
indicated in plate VI, add an equal volume of distilled water, or,. 
if necessary, several volumes; make comparisons as explained and 
multiply the result with two, three, etc., as the case may be. 

d. Bile Pigments. Choleurea. Under normal condi- 
tions bile pigments do not occur in the blood of animals, 
and are therefore also absent in the urine. Bile pigments 
are always formed in the liver ; if in the course of disease 
they are found in the blood (cholemia) or in the urine 
(choluria) they must have originated in the liver. Bile 
passes into the blood as a result of the congestion of bile 
in the larger bile ducts from whence it passes through the 
lymphatics to the thoracic duct and the general circulation. 

Of the bile pigments, bilirubin alone occurs in the urine; 
exposure to the air may convert this into biliverdin. Urine 
containing bile pigments is usually of a dark color, golden 
yellow, yellowish brown or greenish yellow, and the foam is 
yellow. The foam of urine free from admixture of bile pig- 
ments is white. 

Test for bile pigments. For the qualitative deter- 
mination of bile, we make use of Gmelin's test. Into a test tube 
containing about three cc of concentrated nitric acid with an ad- 



URINARY APPARATUS. 181 

mixture of fuming nitric acid (N02) add a small quantity of 
the urine to be tested being careful that no mixing of the liquids 
occurs. (In case the urine has an alkaline reaction it should first 
be acidulated). If bile pigments are present, various colors will 
appear at the point of contact of the two liquids, of which the 
green color alone is characteristic. 

This antiquated test of Gmelin has been superseded by newer 
and better methods. The following are recommended: 

Rosenbach's test. Filter the urine through a piece of white 
filter paper; to the paper thus saturated with the urine add a drop 
of nitric acid. If bile pigments are present, the characteristic 
color rings will appear encircling the drop. 

According to Dragendorf, this test is neatly performed by 
dropping some of the urine on a porous plate of earthenware 
and then adding the nitric acid as above. 

Salkowski's test will sometimes give results when other tests 
fail. Add milk of lime or calcium chloride to the urine, collect 
the precipitate by filtration, wash with a stream of water, then 
dissolve the washed filtrate in hydrochloric acid and alcohol 
(5:100) and heat. Bilirubin, if present, is oxidized into biliverdin, 
producing a green color. 

Choleuria occurs : In retention of bile in the liver 
as a result of occlusion of the ductus choledochus in duodenal 
catarrh, presence of tumors, parasites, concrements. 

In lupinosis and phosphorus poisoning as a result of 
swelling of the liver and obstruction of the bile ducts. 

In all of these cases the feces are deficient in normal bile 
contents and as a result appear of a lighter color. 

When the bile secreted is of abnormal consistency 
(hypercholia), its flow is interrupted and stagnation occurs. 
This results in the course of the destruction of large num- 
bers of red blood corpuscles ; also in the course of haemo- 
globinaemia, lumbago, septicemia, pyemia, burns, internal 
hemorrhage, prolonged chloroform narcosis and similar 
poisonings. In addition to choleuria the feces also contain 
much bile. 



182 



CLINICAL DIAGNOSTICS. 



Grape 



Fig. 41. 




sugar, Glycosuria, by means ordi- 
narily employed can be detect- 
ed in urine in disease only, viz. 
in diabetes m e 1 1 i t u s. In horses 
this disease has been observed in a few 
instances only, in dogs it is common. We 
suspect the presence of sugar in polyuria 
when the specific gravity of the urine is 
high. 

Chemical determination. If albumin is 
present this must first be removed by adding 
acetic acid, boiling, and filtering. Then add 
to 10 cc urine 1 cc caustic potash solution; if 
this produces cloudiness, filter again. Then 
add about 3 drops of a 10% solution of sul- 
phate of copper. The appearance of a light 
blue color is in itself an indication of grape 
sugar; now heat the fluid, if grape sugar is 
present an orange yellow precipitate which 
gradually extends downward is formed at the 
surface; this is an oxide of copper. 

This test (Trommer's test) 

is by no means reliable for horse 

latter contains other bodies that have a 

Pyrocatcchin, etc. On the other hand, 

substances that prevent the reduction (or precipitation) of 

oxide of copper may be present. Pure grape sugar, when 

added to horse urine, can sometimes not be detected at all 

by means of Trommer's test. In all cases of doubt we must 

therefore resort to the fermentation test, as follows : 

Boil 20 cc of urine that has been freed from albumin, let cool 
and add a piece of baker's yeast as large as a pea, shake thorough- 
ly, pour into a fermentation tube and close the latter with metallic 
mercury. Keep the tube at room temperature for 24-48 hours. If 
sugar is present fermentation will set in and the C0 thus pro- 
duced will collect in the top of the tube where the percentage is 
indicated by a graduated scale. 

C 6 H 12 O fl = 2C 2 H B OH 2 +CO, 
Grape sugar = alcohol -f- carbondioxide. 

This test can of course be relied upon only when we 



Fermentation tube. 

urine because the 
reducing power : 



URINARY APPARATUS. 183 

are assured of the quality of the yeast and that it is free 
from traces of sugar. 

The phenylhydrazin test (C6H8N2) of V. Jacksch (Modifica- 
tion of Esch'baum) is very reliable for the urine of the dog (Regen- 
bogen). Mix 5 drops of phenylhydrazin, 20 drops of glacial acetic 
acid and 50 drops of urine in a test tube and boil gently for one 
minute; add 25 drops of officinal sodium hydrate solution and 
again raise to boiling point. Allow the mixture to settle for 12-24 
hours and then make a microscopic examination of the sediment. 
If the urine contained sugar bunches of yellow, needle-like crystals 
of phenylglukosazone will be found. 

Fig. 42. 




Carbonate of Lime. 

Lactose occurs in the urine of cows advanced in preg- 
nancy, disappears after calving and reappears when the milk 
ducts become obstructed. 
C. Microscopical Examination oftheUrine. 

If the examination thus far conducted reveals any im- 
portant alterations, we complete the same with the micro- 
scope. A microscopic examination of the urine 
in diseases of the urinary organs is of even 
greater importance than a chemical analy- 
sis. 



184 CLINICAL DIAGNOSTICS. 

Method. Pour some of the urine into a conical glass, previ- 
ously stirring the same with a glass rod to be sure to get an 
average sample. The urine is then set away to allow the solid 
particles to settle out.; with horse urine this is a rather slow 
process. To prevent decomposition during the process of sedi- 
mentation, add a few drops of chloroform. Remove some of the 
sediment with a pipette and examine a drop on a slide, under 
the microscope. 

A. Crystalline Constituents of Urine. 

The reaction of the urine itself gives us a certain clue 
as to the character of~~the sediments. The normal alkaline 
urine of herbivora contains (see p. 151) carbonate of 
lime and small quantities of neutral phosphates Ca 3 (P0 4 ) 2 . 
• Such sediment does not dissolve when heat is applied, but the 
addition of hydrochloric acid produces solution, and develop- 
ment of CO,. The sediment which forms in the acid urine 
of carnivora consists of acid urates and acid phos- 
phates which dissolve on being heated. 

To determine accurately the nature of the crystalline 
sediment a microscopical examination must be made ; the 
forms of the crystals indicate their nature. Amorphous salts 
can be recognized by micro-chemical tests only. 

a. Carbonate of lime crystallizes in globules with radi- 
ate markings, if the globules are large a concentric marking 

Fig. 43. Fig. 44. 





Oxalate of Lime. Uric Acid. 

can also be observed. Carbonate of lime crystals also occur 
in form of breakfast rolls, dumb-bells, whetstones and 
crosses. Amorphous powder of carbonate of lime can be 



URINARY APPARATUS. 



185 



recognized by the fact that the addition of acetic acid causes 
an evolution of gas. 

b. Oxalate of lime crystallizes in square octahedra that 
have strong light-refracting power, other forms occur but 
are not characteristic. Acetic acid dees not affect oxalate 
of lime, hydrochloric acid dissolves it. It occurs in small 
quantities in alkaline urine, to a greater extent in acid urine, 
but is of no importance for diagnostic purposes. 

c. Uric acid and its salts are normal constituents of 
the urine of carnivora but traces of them also occur in the 
urine of herbivora. 

They commonly occur as an amorphous powder or in 
the form of crystals ; whetstone, rhombic plates, pointed crys- 




Fig. 46. 




Hippuric Acid. 



Triplephosphate Crystals. 



tals, frequently occurring in the form of minute druses. A 
characteristic consists in the peculiarity that, on crystallizing, 
they attract the pigment of the urine which gives them a 
yellowish brown color. They dissolve in a solution of caus- 
tic potash, and they are precipitated in the form of rhombic 
prisms by the addition of hydrochloric acid. 

d. Hippuric acid and its salts form rhombic quadrilat- 
eral prisms and needles which dissolve in hydrochloric acid. 
Normal constituent of urine of horses. 



186 



CLINICAL DIAGNOSTICS. 



e. Triple phosphate of ammonia and magnesia P0 4 
MgNH 4 crystallizes in coffin-lid forms, dissolves in acetic 
acid without giving off gas. Does not occur normally in 
freshly voided urine, but always forms when urine is exposed 
to the air for some time {fermentation) . If found in fresh 
urine it indicates that ammoniacal fermentation has taken 
place in the bladder, cystitis^ pyelitis. 

f. Sulphate of lime, gypsum, occurs occasionally and 
in small quantity in the form of columnar prisms or plates 
in acid urine. It is abundant after internal administration of 
sulphates (Glauber salts). Of no importance. 

B. Organized Elements of Urine. 

In the diagnosis of diseases of the urinary organs these 
are of the greatest importance. The addition of Lugol's So- 



Fig. 47. 




Sulphate of Lime. 



lution to the sediment is an aid in recognizing the cellular 
elements under the microscope. 

g. Epithelial cells in small number are found in 
normal urine, occasionally we find two or three pavement 
epithelial cells in one cover glass preparation. On the other 
hand the finding of epithelial cells from the uriniferous tub- 



URINARY APPARATUS. 187 

ules (renal epithelia) is an exception under these conditions. 
Marked increase of epithelial cells is due to a pathological 
desquamation, hence is observed in catarrhs and inflammation 
of the membranes concerned. It is important to 
be able to recognize the origin of the 
cells by their for m. 

Renal epithelium is roundish or more or less 
cubical and granulated with proportionately large granules 
and is m uch smaller than the pavement epithelium of 
the pelvis of the kidney, the urethra and the bladder. They 
occur singly or several united and not infrequently show signs 
of fatty degeneration. Their occurrence indicates a renal 
affection, but whether or not inflammation exists must be de- 
termined by further examination of the urine. 

Pavement epithelia from the pelvis of the 
kidney, the urethra and the bladder resemble each other and 
cannot be distinguished as to their particular source. They 
are large, flat, polygonal, transparent, nucleated pavement 
cells. Those coming from the surface layers of the mucous 
membrane are more roundish or polygonal, those from the 
deeper layers are more oval, or cone shaped and may contain 
one or more protoplasmic projections that give them a toothed 
appearance. If a considerable number of such cells are pres- 
ent a catarrhal condition of the corresponding mucous mem- 
branes is indicated. 

h. White blood corpuscles or pus cocci are spherical, 
granulated, nucleated cells that are cleared or become trans- 
parent when treated with acetic acid. They may have come 
from the kidneys or from the urinary tract; if from the kid- 
neys we also find casts, if they occur simultaneously 
with numerous pavement epithelia and crystals of triplephos- 
phate they come from the bladder. 



188 CLINICAL DIAGNOSTICS. 

i. Red blood corpuscles, when found in the urine, 
have lost most of their coloring matter, are pale and swollen. 
Those coming from the upper portions of the urinary tract 
have undergone these changes to a greater extent than those 
coming from the lower portions. Thorough admixture of red 
corpuscles with the urine, thus retarding sedimentation of the 
former, points to renal hemorrhage ; blood casts always point 
to renal hemorrhage. Large masses or clots of blood, not thor- 
oughly mixed with the urine, come from the bladder. An 
admixture of blood with the urine (hematuria) occurs in: 

1. Diseases of the. kidneys: injuries, hem- 
orrhagic nephritis, embolic nephritis ; 

2. Diseases of the urinary tract: pyelonephritis, cys- 
titis, red water of cattle, cystic calculi, cystic tumors, in- 
juries of the urethra. 

k. Urinary casts are cylindrical bodies that were 
molded in the lumen of the uriniferous tubules. In the urine 
of the horse we find similar structures under normal condi- 
tions ; they consist of strings of mucus of variable thickness, 
sometimes macroscopically visible and granulated with de- 
posits of amorphous carbonate of lime. Addition of acetic 
acid causes the granules to disappear with the formation of 
C0 2 . In acid urine we find uric acid salts instead. These so 
called granule casts, lime casts, or cylinderoids have noth- 
ing whatever in common with true urinary casts. They 
are especially common in the transition stage from oliguria to 
polyuria. 

The true urinary casts are distinguished as follows : 

1. Hyaline casts, slender, transparent, homogeneous 
bodies of various sizes and not sharply defined contour. They 
are rare, occur in health as well as in disease, are of no diag- 
nostic importance and their origin is unknown. 



URINARY APPARATUS. 



189 



Fig. 48. 




Fig. 49. 




Epithelial 
Casts. 



Granular Casts. 



2 Epithelial casts consist of renal epithelia 
agglutinated with exudates and forced out of the 
tubules by the pressure of the 
urine above them. Frequently 
red and white blood corpuscles 
are associated with them. Such 
cylinders, providing they occur 
in any appreciable numbers, al- 
ways ' indicate inflammation of 
the kidneys. These epithelial 
cells may also have undergone 
fatty degeneration. If they con- 
tain no cells they are called 
granular casts, and have the 
same significance as the epithelial cylinders. 

3 Blood corpuscle casts are formed of agglutinated red 
corpuscles and are due to renal hemorrhage. If these casts 
contain many white corpuscles they indicate purulent inflam- 

mation (pus-casts). . 

1 Examination for micro-organisms is of value in 
case of fresh urine only, because urine that has been standing 
for some time will soon become filled with great masses of 
bacteria and mold fungi from the air. Large numbers of 
bacteria in fresh urine occur in pyelonephritis bactentica and 
in chronic cystitis. , 

Bacillus pyelonephritis bovis will. ^\^ZTV sediment 

of the urine, stained with f »* a V £ ^ T \ v qua ioO) added, 

drops of Lugol's .solution (Iod 8 Pot lod 4. according to 

then decolorized in alcohol. All bacte na mat si 

Gram's method have now assumed a dee P "^ foior, vv 

the rest are decolorized, f^^onep^app^aa a ta Jed and 

rounded ends. 2-3u long and 0.7u in diameter, ev«n> 

usually occurring in little groups. 

Ill Examination of the Urinary Organs. 
Topograph, I . th . bo r s e a „ d « . « . . b e 1 .M k I d - 
?e7< um? .hi Agh.Wdney'hes further forward and cannot be 



190 CLINICAL DIAGNOSTICS. 

reached by the hand. In the horse the left kidney extends back 
to about four inches behind the last rib and its inner border is 
separated from the median line by about the same distance. In 
the ox it is loosely suspended below the lateral processes of the 
first lumber vertebrae. Sometimes it may be shifted over to the 
right side. In the dog the kidneys lie in the lumbar region, the 
right somewhat more anterior than the left; hence the left kidney 
can be more easily felt from the outside than the right kidney. 

In palpating the kidneys follow the general 
rules for this method of examination (see p. 23). In pyelone- 
phritis of the ox the kidneys are enlarged and firm, the ureters 
distended and their walls thickened and firm. 

Examination of the bladder, per rectum, 
in the horse and ox, is quite practicable ; in the dog the ex- 
amination must be made by external palpation. The extent 
to which the bladder is filled is of importance ; if empty, in the 
horse and cow, it represents a soft pearshaped body lying on 
the floor of the pelvis. If well filled it can be felt as a dis- 
tended body projecting far beyond the anterior border of the 
pelvis. To feel it the hand need not be inserted much fur- 
ther than to the wrist. The contents of the bladder can be 
removed by a steady but moderate pressure applied with the 
hand, or by means of the catheter ; this may be important to 
determine whether evacuation is possible. If the bladder is 
ruptured, which is most common in oxen with urethral calculi, 
it is permanently small and flabby. 

Cystic calculi and tumors in the bladder can be recog- 
nized with certainty only when this organ contains little or 
no fluid contents. 

Examination of the urethra is of conse- 
quence in male animals, particularly in oxen, when the pres- 
ence of calculi may be suspected. As a rule these are lodged 
in the upper or lower portion of the S shaped curve. Pressure 
exerted at the point where the obstruction is located produces 
pain. As long as the bladder is not ruptured urine may drib- 
ble from the distended urethra. Unfortunately catheteriza- 
tion is impossible in the ox (sharp curves and narrow lumen 



URINARY APPARATUS. 191 

of urethra) ; in the horse and dog this examination is easy 
and reliable. 

Diseases of the Urinary Apparatus. 

Passive hyperaemia of the kidneys occurs as a result of chronic 
heart and lung troubles. Urine is decreased, sp. gr. increased, 
albumin present. Symptoms more conspicuous after exertions. 

Acute diffuse nephritis. This is primary only in cases of 
poisoning with irritating substances, otherwise it is a symptom 
of severe infections. Dysuria, stranguria, pain in the region of 
the kidneys, stiff gait and crooked back. Considerable diminu- 
tion of renal secretion (anuria), thick and viscid, turbid, high sp. 
gr., acid, much albumin. Microscopic examination most important: 
granular casts, renal epithelia and blood corpuscles. Stupefaction, 
difficult breathing, oedematous swellings. 

Nephritis suppurativa. Secondary affection and usually of less 
importance than the primary disease. Intermittent fever, exhaus- 
tion, emaciation, urine contains albumin, pus corpuscles and micro- 
organisms. 

Chronic nephritis. No fever, develops very slowly. Anorexia, 
exhaustion, emaciation. Pulse strong and hard, heart hypertro- 
phied. Increased amount of urine, low sp. gr., amount of albumin 
slight, few epithelial cells and casts. 

Cystitis, inflammation of the bladder. Continuous efforts to 
urinate, hence small quantities or only a few drops are voided at 
a time. Urination painful, restlessness, groaning, animals remain 
for a long time in a "urinating attitude." Urine cloudy, alkaline, 
slimy or purulent sediment, ammoniacal odor. Pus corpuscles, 
red blood corpuscles, numerous pavement epithelia, phosphate of 
ammonia and magnesia. 

Retentio urinae. Retention of urine. Complete (ischuria") or 
partial suppression of urination; in the latter case it is voided in 
drops and with symptoms of pain. Palpation of the bladder very 
important: distention, pain on pressure. Animals indisposed, in- 
active, do not lie down, appetite diminished, pulse increased, 
sweating. After rupture of bladder has occurred the pains disap- 
pear, animals feel more at ease, bladder is empty. Then come 
chills, high fever, urinous odor of transpired air. 

Incontinentia urinae. Paralysis of bladder. Involuntary flow 
of urine, especially during motion. 

Hematuria is a chronic productive cystitis of the ox, with 
tendency to hemorrhage. Blood corpuscles and clots in the urine. 
Hemoglobinuria of the ox. Hemoglobinemia. Fever, par- 
tial loss of appetite, diarrhea. Urine light red to dark red, foams 
readily, urination painful, reaction at first acid, later on alkaline, 
contains hemoglobin, on boiling coagulates as gelatinous mass. 

Pyelonephritis bacteritica bourn. This is a chronic purulent 
inflammation of the ureters and pelvis of the kidneys which spreads 



192 CLINICAL DIAGNOSTICS. 

to the kidneys and is caused by a specific bacillus. Gradual ema- 
ciation and general depression. Intermittent fever. Urine thick 
and slimy, cloudy, gray or grayish brown, white and red blood 
corpuscles, casts, numerous pavement epithelia, crystals of triple 
phosphate, and bacilli, Bacillus pyelonephritidis bourn. Stain 
according to Gram, 2-3 micra long, 0.6-0.7 micra in diameter, non- 
motile, straight or slightly bent, rounded at the ends. 

Diseases of Tissue Metabolism. 

Diabetes insipidus, polyuria, pissing, is an independent disease 
in which large quantities of clear watery urine are passed continu- 
ously. Daily quantity of urine passed equaling as high as 30 liters. 
Urine as clear as water or slightly yellow, acid, sp. gr. 1001-1010, 
no albumin, little indican. Diminished appetite, desire for alkalies, 
[earth, etc.] emaciation. 

Diabetes mellitus, sugar in the urine, is very rare in horses, 
more common in dogs. Polyuria, ravenous appetite and thirst, 
rapid emaciation. Urine has high sp. gr., 1024-1045, and contains 
grape sugar. 

10. The Sexual Apparatus. 

Most of the organs of the sexual apparatus may, for the 
greater part, be subjected to direct inspection and palpation; 
their examination should he conducted according to general 
rules, care being observed that no parts are overlooked. For 
evident reasons the female sexual organs are more frequently 
affected with diseases than those of the male. Most of these 
diseases belong to the field of obstetrics. 

I. Abnormally increased sexual desire manifests it- 
self not only by sexual excitement but also by psychic disturb- 
ances and altered sensibility, these often resembling diseases 
of the central nervous system. In females this condition is 
known as nymphomania, in males as satyriasis; continued 
erections of the penis is called priapism. 

Mares are usually very ticklish and easily excited, if 
touched with the hand or harness they squeak or cry out, 
switch their tail, back up against persons or against the 
wagon tongue, kick, urinate, and can be used for their regu- 
lar work only when special care is exercised. In rare cases 
they may act like dummies (general depression of the senso- 
rium) and show symptoms of hyperesthesia. 



SEXUAL APPARATUS. 193 

Cows show symptoms of great restlessness, are very 
excitable, bellow frequently, attack strangers, etc. Milk se- 
cretion is reduced, the milk has a bad taste and sometimes 
curdles when boiled. 

In horses and bulls satyriasis manifests itself by 
restlessness and excitable, sometimes vicious, actions. 

In many cases the cause of these conditions cannot be as- 
certained; in cows tuberculosis of the ovaries, in horses cryp- 
torchism, is often the cause. 

A. Female Sexual Organs. 

II. The vulva. In bitches we observe swelling of the vulva 
and a bloody mucous discharge at the oestral period. In cows a 
tough glassy mucus is discharged just before parturition. This 
mucus comes from the neck of the uterus which it served to close. 

A slight swelling of the vulva occurs in vesicular eruption 
of this region ; small vesicles the size of a millet seed, and 
swelling may also occur in the adjacent skin in this condition. 
In puerperal septicemia the vulva swells conspicuously. 

In torsion of the uterus the vulva is retracted and 
drawn into folds; however, exploration per vagina 
is necessary to definitely determine this condition. 

Discharge from the inferior commis- 
sure of the vulva and soiling of the surrounding skin 
and tail are observed in : 

a. Catarrh of the vagina and uterus. In chronic catarrh 
(fluor albus) the discharge is of a thick slimy character 
and glassy ; in acute catarrh the discharge is of a t h i n slimy 
character and discolored. 

b. Retention of the afterbirth ; an ill-smelling, discolored 
fluid mixed with fragments of the fetal membranes is dis- 
charged. 

c. Vesicular eruption ; the discharge is slight, slimy or 
purulent, sometimes mixed with blood. 

d. Tuberculosis ; slight, chronic, muco-purulent discharge 
containing tubercle bacilli. 



194 CLINICAL DIAGNOSTICS. 

III. Vaginal mucous membrane. Whenever there is 
discharge from the vagina the vaginal mucous membrane 
should be examined. 

Method. Grasp the tail near its root, raise it well up, and let 
it rest on the back of the other hand, thus leaving the fingers of 
that hand free to open the lips of the vulva. In order to examine 
deeper-lying parts an assistant should hold the tail and the opera- 
tor can then insert his whole hand, which must be previously 
covered with oil. After thorough palpation in this manner the 
other hand may also be inserted, the vaginal walls spread apart, 
and their mucous membrane inspected; here artificial light may be 
of advantage. A vaginal speculum is not absolutely necessary for 
these examinations. 

By means of direct examinations like these, affections of 
the vagina can best be observed and their character deter- 
mined. In vesicular eruption yellowish gray nod- 
ules, vesicles or ulcers, the size of a millet seed, are found on 
the slightly and diffusely reddened mucous membrane. After 
healing, light specks that indicate the position of former vesi- 
cles and ulcers can be observed for some time. 

In torsion of the uterus the vagina is con- 
tracted, and the mucous membrane is drawn into twisted folds. 
The examination of the uterus and the explanation of changes 
in that organ belong to the field of obstetrics. 

IV. The udder. In the examination of cows 
the udder must never be neglected. In- 
quire at least as to quantity and quality of the milk. Observe 
the color of the skin and note any changes that may have taken 
place. The teats of cows and sheep may be affected with 
pox, in foot and mouth disease the teats of cows may be cov- 
ered with blisters; we also find milk fistulae. Observe also 
the relative size of the different quarters of the udder and the 
condition of the surface ; note the size, position, and direction 
of the teats. In palpation each quarter should be sep- 
arately felt, its size and consistency noted and sensi- 
tive or kn o t te d areas observed. The teats should be 
soft and the milk canal should not be felt; if 
.thickenings or swellings exist, their location, extent, size and 



SEXUAL APPARATUS. 



195 




form should be determined. Finally, milk every teat in order 
to determine the ease with which the fluid can be drawn, no- 
tice the size of the stream and the character of the milk, 
whether it is c 1 o 1 1 e d or bloody: A microscopical ex- 
amination of abnormal milk is not 
necessary but may be of value in 
some cases. To determine wheth- 
er a cow is "fresh" a microscopical 
examination of the milk for the col- 
ostrum bodies or corpuscles must 
be made. 

Fig. 50. Colostral Milk. 

Harpooning the udder according to Ostertag. The 
operation may be performed on the standing animal, but bet- 
ter results can be obtained if the animal is cast and secured. 

Wash the field of operation with soap and water, rinse 
with 2 per cent, lysol solution, following this with 50 per 
cent, alcohol. With hooked forceps grasp the skin overlying 
the suspicious area in the udder and at the fold thus pro- 
duced incise the skin and underlying facia with scissors, grasp 
the tissues with the thumb and index finger of the left hand 
and insert the harpoon with the right. When the suspected 
tissue has been reached give the harpoon a half turn and 
withdraw it quickly. The cutaneous wound is closed with 
artery forceps which are allowed to remain ten minutes, 
whereupon the wound is sealed with iodoformcollodion. 

Cows thus treated will give bloody milk for a few days, 
but if carefully performed the operation is not dangerous. 

Tubercles, if contained in tissue thus removed, can usual- 
ly be recognized with the aid of a simple lens. If the exam- 
ination gives negative results it is advisable to repeat the op- 
eration. Tubercle bacilli can always be demonstrated in 
the tubercles. 

In this method a positive diagnosis alone is of any value. 
We can not rely upon negative results. This method is of 



196 CLINICAL DIAGNOSTICS. 

value in cases of suspected tuberculosis where we fail to get 
a tuberculin reaction, or when a suspected quarter is dry and 
the possibility of a direct examination of the milk is excluded. 

Bacteriological Diagnosis of Udder Tuberculosis according 

to Ostertag. 

The most reliable means of recognizing tuberculosis of 
the udder consists in the inoculation of Guinea pigs with a 
sample of milk from the suspected udder. To obtain reliable 
results the milk must be procured with proper precautions : 
Wash the udder with warm water until it is clean, follow this 
with 50 per cent, alcohol and then dry with absorbent cotton. 
Discard the first ten CC of milk drawn. 

One CC of whole milk is used for the inoculation. Inject 
this into the muscles of the inner posterior region of the thigh. 
Upon the appearance of firm, hard, painless and well defined 
nodules the size of small peas or larger, representing the lymph 
glands near the point of inoculation, the animals may be 
killed. Ihese nodules may appear as early as the tenth day 
after inoculation. If the nodules do not make their appear- 
ance, the Guinea pigs are killed at the end of six weeks. The 
presence of tubercle bacilli in the lymphatic glands or in the 
internal organs demonstrates the existence of tuberculosis. 

B. Male Sexual Organs. 
V. Diseases of the male sexual organs are usually of 
a surgical nature. In vesicular eruption we find vesicles, pus- 
tules and ulcers, or scars, on the penis. To examine stallions 
or bulls they may be led up to a mare (or cow) which usual- 
ly results in voluntary protrusion of the organ. In bulls 
manipulation with the hand may answer the same purpose. In 
glanders the testicles may reveal the presence of knotb. 

Diseases of the Sexual Organs. 

Torsio uteri, torsion of the womb, of interest in internal medi- 
cine only when parturition or pregnancy is excluded. Animals are 
restless, kick belly with hind feet and have pains of labor. Exami- 
nation of vagina gives necessary information. 



SEXUAL APPARATUS. 197 

Vaginitis (colpitis), inflammation of vagina. Symptoms vary 
much, according to degree and character of the affection. If in- 
flammation is severe, general health is affected. Animals make fre- 
quent attempts to urinate; small quantities of urine passed at a 
time; animals remain long in a "urinating attitude." Examination 
of vagina gives necessary information. 

Endometritis, inflammation of the womb. Follows parturition; 
intensity of disease varies. General health more or less disturbed, 
fever, discharge from vagina which varies according to character 
of inflammation, is observed particularly when animals lie down. 
Soiled tail, examination of womb according to general rules of 
obstetrics is always indicated. 

Mastitis, inflammation of udder, garget. 

1. Mastitis i n t e r s t i t i a 1 i s . Fever and hot, rather 
firm and painful swelling of udder. Quantity of milk decreased, 
quality not affected. 

2. Mastitis c a t a r r h a 1 i s Udder evenly enlarged, soft 
and elastic, hot. -Teats swollen, hot, sometimes reddened. Milk 
resembling whey. Fever, loss of appetite. Infectious catarrhal 
mastitis is a special form of catarrhal mastitis, infectious, milk 
yellowish. Usually all four quarters affected. 

3. Mastitis parenchjmatosa. As a rule only one 
quarter affected. Fever, appetite diminished, rumination inter- 
rupted, constipation. One-quarter of the udder enlarged, firm, 
hot, sensitive. The teat of the affected udder is usually free from 
inflammatory symptoms, the milk secretion is greatly decreased, 
yellowish, contains muco-purulent flakes which usually contain 
numerous streptococci. 

4. Mastitis tuberculosa. A few nodular enlarge- 
ments, otherwise the udder is tough and flabby. Supra- 
mammary glands enlarged. Tubercle bacilli in milk. 

Vesicular eruption [coital exanthema] is an acute infectious 
vesicular exanthema of the mucous membrane of the vagina and 
the penis. Period of incubation 3-6 days. The vesicles develop 
into little ulcers. 

Mai du coit [seen in U. S. in imported stallions]. Period of 
incubation 8 days to 2 months. Swelling of the vulva and penis, 
formation of vesicles and ulcers. Frequent attempts to urinate, 
increased sexual desire, urticariform swellings of skin, paralysis 
of hind parts. 

II. The Nervous System. 

Diseases of the central nervous system can be recognized 
only by the disturbed functions of its parts, a physical exam- 
ination of the diseased parts is out of the question. We must 
therefore subject each function to a careful examination and 
draw conclusions as to the parts affected from the character 



198 CLINICAL DIAGNOSTICS. 

of the disturbed physiological processes and conditions. To 
diagnose diseases of the central nervous system requires a 
knowledge of the location of the principal 
functions. 

Preliminary remarks on anatomy and physiology. All efferent 
(motor) psychic (conscious and volitional) fibres originate in the 
cortex of the cerebrum, and all sensory fibres and fibres of special 
sense that conduct perceptible impulses terminate in the 
cortex of the cerebrum. The voluntary motor fibres (psycho- 
motor or cortico-muscular tracts, or simply pyramidal 
tracts) course from the cortex, through the pons Varolii to 
the anterior pyramids of the medulla oblongata. Here most of 
these fibres cross over to the opposite side (motor decussation) 
and go to the motor nerves of the extremities, through the lateral 
columns of the spinal cord. A few fibres that do not decussate 
as above described course along the anterior columns of the spinal 
cord and gradually pass over to the other side like the rest, but 
through the white commissure along the course of the cord. 

Hence destructive processes in one hem- 
isphere result in motor and sensory paraly- 
sis on the opposite side of the body. 

The cerebral hemispheres are also the seat of all psychical ac- 
tivities; they are the seat of thought, volition and sensation. Many 
motor centers are also found in the cerebral cortex and 
hence inflammatory conditions of this region may be attended with 
convulsive movements of the muscles. 

The midbrain (crura cerebri, corpora quadrigemini and optic 
thalami) is the seat of the entire mechanism, harmony and equilib- 
rium of all motions. Animals with both hemispheres removed, 
but with the midbrain intact can retain their equilibrium under the' 
most varied conditions. Inflammatory irritation of the midbrain 
produces involuntary movements. 

The cerebellum harmonizes or co-ordinates the movements of 
the body by regulating the succession of muscular contractions. 

The spinal cord, besides conducting impulses to and from the 
brain, contains reflex centers which, when stimulated by afferent 
impulses, cause certain kinds of important movements (defense, 
flight, etc). These movements are carried out independent of any 
action on part of the brain, as is easily proved on decapitated ani- 
mals or where the spinal cord has been cut through. The thus 
isolated cord is as prompt as ever in producing reflex actions. The 
lumbar cord is the special center for defecation and urination, 
which also depend on reflex activity. 

To be able to recognize normal conditions as well as to 

determine the presence and seat of pathological changes in 

the central nervous svstem, observe the following points : 



NERVOUS SYSTEM. 199 

I. Psychic Functions. 
II. Sensibility. 
III. M o t i 1 i t y . 

I. Psychic Functions. 

Since the cerebrum and particularly its cortex is the seat 
of all psychic activities, disease of the same must interfere 
with normal thought, feeling, and volition; movements, sen- 
sations and perceptions of peripheral parts occur unconscious- 
ly. The general mechanism, harmony and equilibrium of 
muscular movements may be entirely intact in this condition. 
Mental disturbances occur in a great many infectious dis- 
eases, in febrile diseases in general, in the course of intoxica- 
tions (poisonings) of varied kinds, and in local diseases of 

the brain itself. 

Therefore, mental disturbances can 
be ascribed to local causes only when 
the possibility of a general cause i s 
eliminated. The disturbances in question consist of 
abnormal excitability or of abnormal depression. 

Mental excitement is the result of cerebral ir- 
ritation—as observed in acute cerebritis. Horses become 
restless, neigh, refuse to be led. try to tear loose from the 
halter, step to and fro, paw, climb up into the manger, are 
anxious and easily frightened. Cattle bellow, snort, shake 
their heads, jump around, and into the manger. Dogs mani- 
fest their restlessness by an aimless running about, barking, 
howling and even biting. Tigs squeal, crawl under the litter, 
run about, climb over obstacles and jump up against walls. 
Similar symptoms are also observed in rabies, acute tubercu- 
lar meningitis, malignant catarrhal fever of the ox and in 
anthrax. 

Symptoms of mental depression frequent- 
ly follow those of excitement. The animals droop the head, 
rest it on the crib or feeding rack, eyes half closed, take no 



200 



CLINICAL DIAGNOSTICS. 



interest in their surroundings, do not recognize familiar per- 
sons, run against obstacles, etc. In feeding they grab the food 
with the incisor teeth, chew slowly and "languidly," stop 
without a motive when food is still in the mouth and between 
the lips. In drinking they plunge their mouth into the water 
and often "chew" it. It is hard to make them move, they 
step around clumsily, won't "get over" when commanded to 

Fig. 51. 




Horse with chronic hydrocephalus. 



do so; they are hard to guide when driven, try to stay over 
on one side ; if badly affected they cannot be used for serv- 
ice because they do not recognize commands. According to 
the degree of mental depression we recognize : 

Dullness; 

Somnolency, sleepiness, drowsiness, from which the pa- 
tient is easily roused. 

Sopor, profound sleep, rousing difficult. 

Coma, profound insensibility. 

A dulling of the psychic functions occurs in ; 



NERVOUS SYSTEM. 201 

1. All acute infectious diseases ; contagious pleuropneu- 
monia, influenza, Rinderpest, anthrax, horse, distemper, dog 
■distemper, septicemia, Rothlauf of swine, etc. 

2. All severe febrile diseases. 

3. Chronic affections of the brain: blind staggers, turn- 
sick of sheep, second stage of acute cerebritis and cerebral 
hyperemia. 

4. Poisoning with narcotics. 

5. Icterus, uraemia. 

G. Chronic gastric and intestinal affections of the horse. 

Dizziness (vertigo) and syncope (fainting) are sud- 
denly occurring temporar y disturbances of conscious- 
ness and loss of equilibrium. Animals suddenly become un- 
steady in gait or standing position, sway, reel, stagger and 
sometimes fall to the ground. The cause may consist of the 
presence of parasites in the brain, hemorrhages, tumors, ab- 
scesses, passive cerebral hyperemia (compression of jugulars 
by harness), aortic insufficiency or stenosis, also the action 
of glaring light ("ocular vertigo"), irritations of the external 
auditory meatus, and of the nasal mucous membrane by para- 
sites, finally also of poisoning with certain plants. 

II. Sensibility. 

The sensibility is tested by artificial stimulation, sticking 
a finger into the ear, flipping the nose with the finger, stepping 
on the coronet, pin pricks. In testing the general sensibility 
observe that no inflammatory condition exists in the part 
"tested." Peripheral irritation may give rise to spinal reflex 
actions, e. g. the hoof may be raised without any conscious- 
ness of the act on part of the animal either as to the act or 
stimulus producing it. For this reason the gen- 
eral behavior of the whole animal must 
be taken into account in testing its 
sensibility. If dogs cry out during such an examination. 
or test we may conclude that conscious feeling exists. 



202 CLINICAL DIAGNOSTICS. 

Decreased sensibility is called hypesthesia, absence of 
sensibility is called anesthesia, abnormally increased sensibil- 
ity is called hyperesthesia. Sometimes sensibility is retarded; 
this is indicated when the reaction occurs an unusually long 
time after the stimulus is applied. 

Hyperesthesia is most frequently seen in old 
ticklish mares, also in lumbar prurigo of sheep and in 
the first stages of cerebritis. 

Diminished sensibility is observed in chronic affections of 
the brain, immobility, tumors, second stage of acute cerebritis, 
parturient fever, second stage of cerebro-spinal meningitis, and 
in narcotic poisonings. 

III. Motility. 

In morbid conditions affecting the cerebral hemispheres 
only we observe no serious disturbances in motility because the 
mid brain and the cerebellum are the seat of co-ordinated 
movements. 

a. Spasms, or cramps, are involuntary muscular con- 
tractions. Spasms of short duration, alternating with relaxa- 
tions, are called clonic spasms; if they are very slight, uni- 
form, rapid, and locally limited we call it trembling; if they 
affect large areas or extend over the whole body we call them 
convulsions. Clonic spasms are observed in partial and gen- 
eral epilepsy and in inflammatory affections of the brain and 
spinal cord (common after dog distemper). Tonic or tetanic 
spasms are muscular contractions that continue for some time 
without relaxation. They are characteristic for tetanus (lock- 
jaw) and strychnine poisoning, causing the body to assume 
a stiff position, especially the head, neck, ears, back, and tail. 
The mouth is closed as a result of contraction of masseter 
muscles, nostrils distended "trumpet like." Stiffness of the 
back without bending is called orthotonus, depression of 
spinal column and bending back of head toward withers, opis- 
thotonus, spasms of the masseter muscles, trismus, spasms of 



NERVOUS SYSTEM. 203 

the extensors of the limb, sawhorse attitude, muscles of the 
eye, prolapsus of the membrana nictitans, cramps of facial 
muscles, risus sardonicus (canine laugh). Tonic spasms in 
connection with clonic spasms are also observed in cerebro- 
spinal meningitis (cramp of the neck). 

All spasms have their origin in the cortex of the cerebrum, 
the pyramidal tracts, or in the anterior cornua of the spinal 
cord. Spasms originating in the cerebrum are attended with 
mental disturbances (epilepsy), not so in case of spinal 
spasms. 

Reflex spasms are due to irritation of peripheral sensory 
nerve endings and are of spinal origin ; they are observed 
when animal parasites occur in the intestines, during the pe- 
riod of shedding teeth, and in painful gastric and intestinal 
affections. 

b. Involuntary movements may be due to irritation 
of one of the cerebral hemispheres or to paralysis of the op- 
posite one. also to affections of the midbrain or of the cere- 
bellum. They always proceed from circumscribed lesions and 
are therefore known as "symptoms of local origin." Some- 
times involuntary movements occur in the muscles of the body 
and extremities, or the usual voluntary movements assume an 
involuntary character. In such cases animals manifest a 
desire to "go ahead," trot with head raised or lowered, run 
against obstacles ; if they get into a corner they are at a loss 
as to how to get out, frequently they fall down in such cases. 
Sometimes, but more rarely, they walk backwards. If the 
cerebral disturbances are unilateral the symptoms tend to be 
the same. The animals walk in a circle (Reitbahnbewegun- 
geu. riding school movements:) they lie down and roll, turn- 
ing on their long axis, or they fix their hind feet as a pivot, 
and walk around with their forefeet — move like the hands 
of a clock. Involuntary movements are most frequently ob- 
served in chronic and acute hydrocephalus, abscesses, hem- 
orrhages, tumors and parasites in the brain. Turn sickness,, 
[gid], of sheep is thus characterized. 



'204 CLINICAL DIAGNOSTICS. 

In so called riding school and clock hand move- 
ment the coenurus is usuatly located on the surface of that half 
of the cerehral hemisphere facing the center of the circle; some- 
times on the optic thalamus of the opposite side. 

If affected sheep move forward with the head down and trot- 
ting motion of the forelimbs (trotters) the seat of the parasite 
is at the anterior end of the hemisphere or on one of the corpora 
striata. 

Staggering gait, reeling, dizziness (staggerers) indicate that 
the parasite is located in or on the cerebellum. 

When the coenurus is located at the base of the cerebellum it 
causes rolling movements of the animal. 

If (lie animals hold their heads up high or backwards and 
move forward rapidly, fall down (sailors), the coenurus is located 
in the posterior portion of the cerebrum. 

c. Disturbances of the muscular sense. The muscu- 
lar sense enables us to recognize the position of the limbs and 
the extent of passive and active movements. As long as equi- 
librium is not affected, an animal suffering from disease of 
the cerebrum can be made to assume unphysiologic positions 
without being conscious of it, in fact they do this themselves, 
they interrupt movements before they are completed or go 
to the opposite extreme and make more extensive move- 
ments than occur normally. 

In acute cerebritis and staggers horses sometimes assume 
peculiar positions of the legs, cross them, set them close to- 
gether or one before the other ; one may be set unduly forward, 
the other unduly under the body. When such positions are 
produced passively the animals make no attempts to change 
them. In moving about they raise their legs unusually high, 
(groping, wading walk) or not high enough and thus stumble 
when they meet obstacles. 

d. Paralyses consist in partial or complete loss of 
power to bring about muscular contractions. Complete in- 
abilitv to move is called complete paralysis; if there is simply 
diminished power to produce movements we call it 
incomplete paralysis (paresis). According to the origin of 
the paralysis we distinguish cerebral, spinal, and peripheral 
paralyses. Paralysis of one side of the body is called hcnii- 



NERVOUS SYSTEM. 205 

plegia, of both sides (both hind legs) paraplegia; paralysis of 
a single organ or part is known as monoplegia. Hemiplegia 
has its origin in the brain, paraplegia in the spinal cord, 
monoplegia in the motor centers of the brain or, and as a 
rule, in peripheral nerves. 

In cerebral paralyses the cranial nerves are 
frequently also affected and psychic disturbances are present; 
we observe cerebral paralysis in 

1. Brain diseases: acute cerebritis, cerebro-spinal menin- 
gitis, abscesses, hemorrhages (apoplexies), tumors, parasites. 

2. Infectious diseases: rabies, mal du coit (always), ex- 
ceptionally in horse distemper, and in contagious pleuro-pneu- 
monia of the horse. 

3. In intoxication diseases : parturient fever, mvcotic 
intoxications, brine poisoning. 

Spinal paralyses are usually cases of paraplegia 
which affect all nerves beyond the point of injury or dis- 
ease and are always attended with sensory paralysis. 
Psychic disturbances are wanting. They are caused by : 

1. Spinal fractures; 

2. Diseases of the cord : inflammation, hemorrhage, tu- 
mors, parasites ; 

3. Infections diseases : dog distemper, rabies, rarely in 
contagious pleuro-pneumonia of the horse. 

Spinal paralyses also affect the veg- 
etative branch of the nervous system, 
since the lumbar cord is the center for the production of the 
contractions that produce defecation and urination. Hence 
paralysis of the rectum and bladder with the inevitable results 
(impaction of rectum and distention of bladder with urine) 
occurs. See pp. 137 and 148. 

Peripheral paralyses are for the most part of 
surgical interest. In internal medicine paralysis of the fa- 
cial nerve, because it interrupts normal feeding, and paralysis 
of the recurrent nerve, because it disturbs respiration, are of 



206 CLINICAL DIAGNOSTICS. 

interest. These two morbid conditions have been considered 
more in detail elsewhere. 

e. Reflex excitability. Reflex movement is a tem- 
porary muscular contraction brought about by stimulating a 
peripheral (sensory) nerve ending. In order that reflex move- 
ment may occur the sensory and motor nerve fibres and the 
reflex center must be intact. Reflex movement is limited to one 
muscle or muscle group (simple reflex) or it may affect the 
whole body and in that case may be inco-ordinated (reflex 
.spasm) or co-ordinated (motions of defense or flight). The 
following physiological reflexes are of clinical importance : 

a. Reflexes of the Brain. 

1. Closing of the eyelids. The sensory 
fibres (trigeminus) of the cornea, conjunctiva and of the skin 
in the neighborhood of the eye conduct impulses to the medulla 
oblongata and from that point the facial nerve produces con- 
traction of the orbicularis of the eyelids. 

2. Sensitiveness to light on part of 
the pupil. Increased reflex excitability 
occurs in tetanus and in strychnine poisoning. Contracted 
pupil is observed in morphine, eserine and pilocarpine poison- 
ing. 

Decreased reflex excitability in great 
mental depression, excessive pain and in dyspnoea of high 
degree. 

Dilated pupil (mydriasis) occurs in paralysis of 
the optic nerve (black cataract) and in paralysis of the oculo 
motor nerve (atropin poisoning). 

b. Spinal Reflexes. 

1. Skin reflexes consist of muscular contractions fol- 
lowing irritation of sensory peripheral nerves, e. g. manipu- 
lation or percussion of the walls of the chest or the flank. 
Touching the anus causes contraction of the sphincter ani 



NERVOUS SYSTEM. 207 

(anal reflex) ; touching the skin at the perineum results in 
drawing up of the tail and depression of the croup. 

2. Mucous membrane reflexes. Pressure upon the 
larynx or the upper rings of the trachea produces a cough 
(laryngeal reflex). 

3. Tendon reflexes. Striking the flexor tendons of 
the carpus, the inferior patellar ligaments or the achilles ten- 
don causes the animal to raise its legs. 

4. Normal defecation and urination. 

Spinal reflexes are diminished or ahsent in disturbances 
of the reflex arc, hence in peripheral paralyses and diseases 
of the spinal cord. Increased reflexes are observed in hyper- 
esthesia, strychnine poisoning and in diseases of the reflex 
inhibitory centers of the brain. 

Diseases of the Nervous System. 

Cerebral congestion. Hyperemia of short duration, fluctuat- 
ing in character and entirely curable. Begins with stage of ex- 
citement; animals are restless, try to force themselves forward or 
sideways, rear, kick, shake their heads, walk backwards, tear the 
halter strap, etc. After a few hours the stage of depression sets 
in: animals are stupefied, sad look of the eye, head down, disregard 
familiar commands. 

Acute inflammation of the brain, acute hydrocephalus. Differs 
from congestion in its" more pronounced symptoms and its longer 
duration. In the second stage (that of depression) we observe 
abnormal attitudes and movements, staggering, sometimes falling 
down and inability to get up again, sometimes attacks of raving 
madness. Temperature frequently increased, but fever may be 
absent. Feeding always more or less interrupted, especially the 
manner of feeding. 

Blind staggers. Morosis equorum. Hydrocephalus chronicus. 
This is a chronic apyretic incurable affection of the cerebrum which 
manifests itself by mental disturbances, and by impaired locomo- 
tion and sensibility. Pulse strong and full, number of heart beats 
never increased, but frequently diminished — a very constant symp- 
tom. Appetite usually good but animal eats slowly. Ability 
to work present to a limited degree. Examination for staggers. 
See p, 180. 

Epilepsy. "Falling sickness" is a chronic disease of the brain 
characterized by paroxysms occurring at intervals and attended 
by sudden loss of consciousness and disturbed sensibility. 

Dizziness, vertigo. This is a primary disease, occurring at 



208 CLINICAL DIAGNOSTICS. 

intervals, characterized by interrupted equilibrium and due to cir- 
culatory disturbances in the brain. 

Cerebral hemorrhage. Apoplexy. Sudden dizziness, involun- 
tary movements, loss of consciousness, falling down, paralysis 
(hemiplegia and monoplegia). 

Eclampsia is an acute epilepsy, ending in recovery or in death. 

Turnsick is a disease of sheep caused by the presence of the 
larval form of 'Tenia coenurus in the brain. 1st stage, cerebral 
excitement; 2nd stage, latent stage; 3rd stage is that of turnsick, 
characterized by symptoms of local brain affections. 

Paralysis of the facial nerve. In case of peripheral paralysis 
the cheeks, lips and nasal muscles are paralyzed, usually unilater- 
ally; if paralysis is bilateral we have dyspnea and difficulty in 
feeding. In case of central paralysis the upper eyelids droop, 
eyes cannot be closed and the auricular muscles are affected. 

Lumbar prurigo of sheep is a chronic, hereditary affection of 
the spinal cord characterized by hyperesthesia, weakness and 
paralysis of the hind parts and by progressive emaciation, invaria- 
bly leads to death. 

Infectious Diseases with Localization in 
the Central Nervous System. 

Tetanus is an intoxication produced by the entrance 
of the products of the tetanus bacilli into the blood. Spasmodic 
condition of the entire skeletal muscles, animal is stiff, eyes re- 
tracted, membrana nictitans prolapsed, head and neck bent back, 
back depressed, tail erect. Sawhorse attitude of legs, hock turned 
out, producing bowleggedness. Spasm of masseter and pharyngeal 
muscles interfere with mastication and deglutition, spasm of the 
respiratory muscles affects respiration. Great excitability; thus 
aggravating the general muscular cramps. At first no fever, later 
on the fever is high. Pulse strong and full. Animals do not lie 
down, or when down they cannot get up. Mental condition is 
normal. 

Rabies is a strictly infectious disease characterized by disturb- 
ance of the central nervous system. 1. Initial stage. Dogs 
are restless, moody, easily frightened, want to be out of doors, 
depraved appetite. 2. Raving stage. Aimless running about, 
tendency to bite, sometimes break their own teeth in the act, 
voice changed to a barking howl. 3. Paralytic stage. 
Emaciation, lower jaw paralyzed, tongue extended, hind quarters 
paralyzed. Horses show restlessness as in colic, neigh in a 
peculiar shrill or yelling manner, try to gnaw or bite the point of 
infection, bite the manger and not infrequently fracture the lower 
jaw in the act. Paralysis and death follow within three days. 
Cattle bellow and run against objects with their horns, frequently 
fracturing them. Sheep and pigs also manifest a desire to bite. 

Infectious cerebro-spinal meningitis. Disease is frequently in- 
troduced with chills. Slight fever. Sensibility reduced, animals 



BODY MOVEMENTS. 209 

are drowsy, stumble and fall on slight provocation. Turning of 
eyes, jerking of muscles, later on paralysis. Tonic spasms of the 
cervical muscles; head drawn to one side. 

Intoxication Diseases. 
Parturient paresis, milk fever, is an acute auto-intoxication 
;ely following the act of narturition. and rhnrxrtnriwr] k« r*™. 




" IL V a . 1 ,^ w "uuis symptoms or depression and paralysis set in 
Animals lie immovably in a characteristic attitude, see p. 34. Eyes 
closed, paralysis of muscles of head, tongue extended, rattling 
breathing, distention of abdomen, constipation, paresis of paunch. 
Lowering of external and internal bodily temperature. 



C. Specific Examinations. 

We resort to the specific examinations only when definite 
results cannot be obtained with the foregoing- methods, espe- 
cially in cases of differential diagnosis between similar dis- 
eases. In a 1 cases the specific examina- 
tions are directed toward determining 
definite diseases; and the characteris- 
tics of these are specially considered. 
12. Body Movements. 

Many diseases are not observed until the animal is in 
harness or under the saddle, others become more conspicuous 
in their symptoms under these conditions. The rule is to 
examine animals while engaged in their accustomed occupa- 
tion (blind staggers, balkiness). Draft horses should be ex- 
amined when hitched to the wagon, riding horses under their 
rider. Unaccustomed work fatigues animals unduly and ex- 
cites them. Sometimes fatigue and excitement make certain 
symptoms more conspicuous (roaring) ; in such cases we make 
an exception of the rule just given. In all cases we must ob- 
serve that the animal is properly harnessed. 

I. Examination for Immobility. 
(Examination of So-called Dummies). 

Blind Staggers. 
Blind staggers may be defined as an incurable disease of 
the brain accompanied by cerebral depression. It may develop 



210 CLINICAL DIAGNOSTICS. 

gradually or follow an attack of acute hydrocephalus. Ac- 
cordingly, blind staggers is characterized by disturbances of 
consciousness. These symptoms may be observed while the 
animal is at rest, but frequently they are not sufficiently pro- 
nounced so that a diagnosis can be based upon them. Sub- 
jecting a suspicious animal to exercise is a valuable aid in 
making a diagnosis, it furnishes a better opportunity for test- 
ing the psychic functions and the resulting increased blood 
pressure intensifies the existing symptoms. 

It is of diagnostic importance that horses affected with 
immobility can be used for work, though in a limited degree, 
and that horses suffering with acute cerebral affections re- 
fuse to work or, if worked, symptoms of cerebral 
excitement follow. Again, horses with blind stag- 
gers always have a low pulse, eat slowly but nevertheless 
eat a full feed. On the other hand, horses with acute 
cerebral affections have poor appetite and a high, or change- 
able, pulse. 

In examining for blind staggers the horses must be test- 
ed while performing accustomed duties, and care must be ob- 
served not to excite them ; in no case must they be subjected 
to unaccustomed work. It is advisable to drive or ride the 
animal oneself ; notice the facility with which the animal is 
guided, effect of whip and spurs, tendency to go over to one 
side, ease with which animal moves forward or backward. As 
soon as the animal begins to sweat it is taken to a 
quiet place and rested, here we repeat a careful examination 
of the cerebral functions, (the animal's psychical 
condition) ; observe the expression of the eye, effect of sur- 
roundings, general attitude of the body, movements of the 
head, use of eyes and ears. To determine the degree of sen- 
sibility we resort to mechanical irritation : gently inserting a 
finger into the animal's ear, flipping the finger against the nose, 
stepping on the coronet, kicking against the cannon bone. 
Finally the animal's motility is tested to determine whether it 



BODY MOVEMENTS. 



211 



voluntarily assumes unnatural positions (setting a foot ab- 
normally forward or back) whether it advances or backs read- 
ily, follows its leader or not, halts without a command when 
the attendant leading it stops, etc. An important test is to 



Fig. 52. 




Examination of a horse for Blind Staggers. 



attempt to cross the forelegs; horses with blind staggers can 
usually be made to assume this position and throw their weight 
on their feet when thus crossed. To make this test the 
operator stands on one side of the animal, his legs spread so 



s 

212 CLINICAL DIAGNOSTICS. 

that one is in front, and the other behind the front leg of the 
horse, then grasps the foot of the opposite side (at the meta- 
carpus and from behind), forces the horse back a little to 
relieve the foot in question, pulls it over and crosses it in 
front of its opposite. 

Quiet and gentle animals will sometimes remain standing 
in this position and even permit other insults, but from their 
general attitude it is plain that the reason for all this is not 
an abnormal mental state but rather extreme good naturedness. 
Animals greatly fatigued may show symptoms of a depressed 
sensorium, but they are always of short duration. 

A single symptom can never deter- 
mine a diagnosis, we must consider the 
animal's condition as a whole. 

II. Examination for Heaves. 

Heaves may be defined as a chronic, incurable disease of 
the lungs or of the heart, characterized by difficult and la- 
borious respiration. 

This definition is forensic in its sense, and includes a 
number of chronic incurable diseases of the lungs and of the 
heart that are attended with difficult respiration. As a rule 
chronic bronchitis, alveolar emphysema of the lungs, chronic 
interstitial pneumonia or heart disease constitute the anatom- 
ical lesion at the bottom of heaves. Although it is frequently 
possible to determine the exact nature of the anatomical le- 
sion, it is customary, in Germany at least, to apply the term 
"heaves" to all of these conditions, because "heaves" is con- 
sidered as one of those diseases the presence of which is a 
legal ground for the setting aside of a contract of sale and is 
referred to under this name in all laws concerning it. 

The term "difficult and laborious respiration" is com- 
parative in its sense, and in applying it we must always con- 



BODY MOVEMENTS. 213 

sider the nature of the exercise leading to it as well as the 
constitution and anatomical make-up of the animal. On the 
other hand, whether the pathological condition in any way 
affects the use of the animal for some particular purpose or 
not, does not come under consideration. To make a positive 
diagnosis of "heaves" it is necessary only to recognize the 
existence of a difficulty of respiration which is due to a chronic 
and incurable disease of the lungs or of the heart. 

For this purpose a careful examination of the circula- 
tory apparatus and of the respiratory apparatus is indispens- 
able. It is also necessary to determine positive symptoms of 
the disorder under consideration in order to be fortified 
against the possible assertion that the disease is due to other 
causes than chronic and incurable affections of the lungs or of 
the heart. Furthermore, we must exclude, by careful exam- 
ination of all functional apparatus, any acute affections that 
may produce increased respiration. External painful condi- 
tions must also be taken into consideration. 

If it is impossible to differentiate between the effects of dis- 
turbances of this nature and existing symptoms of heaves, it 
would be well, in all cases where legal complications are possible, 
to inform both buyer and seller of the existing conditions and of 
the necessity of withholding the expression of a final opinion 
until the animal has recovered from the existing acute dis 
If, at such a time, the previously observed symptoms of "heave-" 
are still present, the existence of the disease at the time of pur- 
chase must be conceded. 

The examination of a suspected "heavey" horse is con- 
ducted not only while the animal is at rest, but also during 
and after exercise. Animals are worked in an accustomed 
manner and made to exert themselves to a moderate degree, at 
the same time we note the character and frequency of respira- 
tion. The horse should be driven or ridden in a quiet trot : a 
draft horse made to pull a moderately heavy load. Count the 
respirations every 5 minutes and let the animal work until it 
sweats, but not longer than 15 minutes. Then put the animal 
in a stable, count the respirations every 5 minutes and note 



214: CLINICAL DIAGNOSTICS. 

when they return to the normal (the number counted before 
exercising). 

In healthy horses the number of respirations 
runs as high as 50 or ?0 per minute, sometimes even higher. 
Respiration occurs without exertion, the animals may now and 
then give a voluntary snort and take a few deep inspirations. 
In the course of at most 15 to 18 minutes after cessation of 
the exercise, the number of respirations should be reduced to 
that observed at rest. 

"Heavey" horses, on the other hand, show increased 
or difficult brething, dyspnea, (see p. 84). Inspiration and 
expiration may be so difficult that the number is not increased, 
but the character of the respiratory movements enables us to 
recognize the dyspnea. But as a rule the number of res- 
pirations, when animals are exercised as above described, runs 
up to 80 to 120 per minute and goes back to the normal very 
gradually. Not infrequently this requires 30 to 60 minutes. 
In chronic bronchitis a white foamy nasal discharge is ob- 
served. 

III. Examination for Roaring. 

The term "roaring" is applied to a form of breathing 
attended with the production of an audible sound and due to 
a chronic, incurable disease of the larynx or trachea. 

As a rule, roaring is caused by a paralysis of the 
left recurrent nerve and the resulting inactivity and degener- 
ation of the muscles which it supplies (Hemiplegia laryngis 
sinistra). 

In rare cases a paralysis of the right recurrent nerve or 
a bilateral paralysis may exist; sometimes thickening of the 
mucous membrane or the presence of tumors may be the cause. 
An exact diagnosis of the cause of such a stenosis can be defi- 
nitely determined only with the aid of the laryngoscope ; but 
in 99 per cent, of all cases a left handed paralysis is the cause. 

Except in rare cases, laryngeal roaring is no- 



BODY MOVEMENTS. 215 

ticed only in forcible or increased respiration, and is then 
characterized by a harsh, sharp inspiratory 
noise or tone (wheezing, whistling, blowing, hum- 
ming, roaring, snoring.) The respiratory noise is caused by 
the fact that deep and rapid inspiration causes the air current 
to force the paralyzed arytenoid cartilage and vocal cord into 
the lumen of the larynx and thus obstructs its free passage. 
Decreasing the volume of the ingoing current of air by com- 
pressing the nostrils causes the noise to cease. Pressure on 
the paralyzed arytenoid cartilage increases the noise. Pres- 
sure on the right (unaffected) cartilage increases dyspnoea to 
such an extent that inspiration is almost impossible, it ceases 
entirely or continues with a sharp wheezing sound, because 
the lumen of the larynx is now obstructed by both arytenoid 
cartilages. 

In examining for roaring the horse must be placed 
under conditions that force it to make rapid and energetic respira- 
tory movements, it must be "worked hard," pull heavy loads over 
soft ground, or gallop. Exercising or riding are especially adapted 
for this purpose because we can control the position of the head, 
and thus influence respiration. Whether or not the animal is 
accustomed to this sort of exercise has no effect on the general 
result. 

If the head and neck of the animal -are well checked up and 
back, the points of insertion of the dorsal muscles are approxi- 
mated and the action of the latter on the spinal column is reduced: 
now, in order to fix the spinal column the longissimus dorsi, the 
inspiratory and the abdominal muscles must be contracted with 
unusual force; this can be done only at the moment of inspiration. 
In expiration these muscles are relaxed and the animal loses, more 
or less, the control over its spinal column. It therefore makes 
an effort to reduce the expiratory period by rapidly and energetic- 
ally following with the inspiratory movement. If only one aryte- 
noid cartilage projects over the lumen of the larynx the inspiratory 
current forces it in, produces a stenosis and causes the respiratory 
sound. By turning the head toward the right the in-streaming 
current of air is directed on the left arytenoid cartilage, and if the 
paralysis is only an incomplete one the characteristic sound is pro- 
duced just the same. 

This kind of treatment can never pro- 
duce roaring in a health}- horse. 

In order to make a positive diagnosis of "roaring" it 
is necessary to eliminate the possible presence of acute morbid 



216 CLINICAL DIAGNOSTICS. 

conditions of the tipper air passages as well as stenoses of the 
nasal cavities since these conditions will also produce audible 
breathing. Contractions or other deformities of the nasal 
cavities can frequently be recognized upon superficial exami- 
nation, or by the wheezing noise they produce. If the trouble 
is unilateral, the peculiar noise will cease upon closing the af- 
fected side, or become more pronounced upon obstruction of 
the healthy nostril. 

If existing lameness or the presence of acute affections of 
the respiratory apparatus or other organs make this method 
of examination impossible, the laryngoscope may do valuable 
service. (See p. 101.) 

IV. Examination for Epilepsy and Vertigo. 

Epilepsy is a chronic cerebral disease that is char- 
acterized by paroxysms occurring at intervals and attended 
with interruption or loss of consciousness and sensibility. 
Vertigo (dizziness) is a similar affection; it is an inde- 
pendent disease occurring in the form of periodical attacks, 
disturbed equilibrium and consciousness. The difference be- 
tween epilepsy and vertigo is that spasms are absent in the 
latter. 

The diagnosis of these two diseases is not diffi- 
cult if one has an opportunity to observe an attack. In the 
intervals horses act perfectly normal. 
Sometimes certain known conditions bring about an attack; 
when making an examination .of suspected animals we can 
often make use of this knowledge to bring on an attack. 
Horses may be hitched up and driven as on former occasions 
when an attack was observed, etc. . The fit of the harness 
should be carefully inspected. Sometimes frightening or ex- 
citing the animal, or driving with the face turned toward the 
setting sun, or along streets sprinkled with alternating shade 
of trees and the glaring light of the sun. will produce an at- 
tack. If we cannot personally observe an 
attack we must base our diagnosis upon 
unobjectionable statements ofwitnesses. 



BODY MOVEMENTS. 217 

Epilepsy. Characteristic epileptic spasms occur either only at 
the head and neck (partial epilepsy) or the whole body is affected 
(general epilepsy). Animals stop suddenly, distort their eyes, 
blink, spasmodically contract the muscles of the lips and face, 
raise their heads high and jerk them to one side, sometimes they 
step to and fro, or backward and forward, restlessly. In general 
epilepsy the spasms rapidly extend over the whole body; mastica- 
tory movements are spasmodic, the saliva is churned into foam, 
the animals grate their teeth, spasmodically distort their neck side- 
ways, the muscles generally undergo spasmodic contractions, the 
animals stagger and fall and then the spasms may continue for 
some minutes. An attack may last from J4 to I 5 minutes, the 
horses then get up and become quieted. The intervals between 
attacks are very irregular. 

The above described idiopathic epilepsy must be distinguished 
from acute cerebral affections and from epileptiform spasms due to 
peripheral irritations (reflex epilepsy). 

Vertigo. Attacks usually occur while animals are at work; 
they suddenly walk slower, nod and shake their heads, snort, raise 
their heads up and sideways, stagger, spread their legs and not 
infrequently fall down. Here they lie quietly, sometimes kick a 
little and then get up again. During the attack there is a loss of 
consciousness and sensibility, sometimes increased respiration and 
profuse sweating. 

Attacks of dizziness due to congestion of the brain (compres- 
sion of the jugulars) and to cerebral anemia (stenosis of aortic 
valves) do not belong under the head of idiopathic vertigo. 

V. Examination for Balkiness. 

Balkiness is refractoriness manifested in common and 
accustomed work. Hence a horse must be tested while at 
accustomed work, and we must proceed with utmost caution 
and quiet and avoid everything that might excite the animal. 
The examining veterinarian must be pres- 
ent during all manipulations and see to it 
that rough or improper treatment is avoided. 

We first examine those parts of the body that bear the 
weight and pressure of the harness and see that no morbid or 
painful conditions exist ; the animal js then properly harnessed. 
In case the harness does not fit, it should be made so by short- 
ening or lengthening parts that may require it, or by using 
a new set of harness. Then the animal is tested in the 
capacity for which it is intended, single or double, as coach 
or draft horse, or under the rider, as the case may be. Active 



218 CLINICAL DIAGNOSTICS. 

or passive refractoriness to reasonable demands is regarded as 
balkiness. 

Young animals, such as are not yet sufficiently accus- 
tomed to work, also evince a certain degree of refractoriness, 
but, as a rule, if properly handled they will soon yield and 
obey willingly, especially if they are hitched with older and 
quiet horses. 

13. Diagnostic Inoculation. 

Diagnostic inoculations consist in the introduction of cer- 
tain substances into the bodies of animals for the purpose of 
determining either the character of the substance or the con- 
dition of the animal's health. We base our judgment on the 
character of the result. For the clinician diagnostic inocula- 
tions serve merely to recognize a few infectious diseases ; cer- 
tain of these diseases have so rapid a course that the clinical 
symptoms cannot be relied upon to determine either their kind 
or character with any degree of certainty. Others which ter- 
minate much less rapidly do not show sufficient symptoms for 
a definite diagnosis. In these cases nothing save 
a correctly performed inoculation will 
serve to recognize the disease or to ob- 
tain an early diagnosis. 

Diagnostic inoculations are always made with respect to 
certain well known infectious diseases which our examination 
leads us to suspect. In performing the inoculation, therefore, 
we must consider the peculiarities of these diseases, we choose 
certain tissues, fluids or other substances for our inoculating 
material, we follow a certain method of inoculation and make 
use of particular animals. 

For inoculation we use 

1. Material of known composition (tu- 
berculin, mallein) in order to determine the condi- 
tion of the animals from the resulting reaction. 

2. Tissue and other material from diseased an- 



DIAGNOSTIC INOCULATION. 219 

i m a 1 s on test or experimental an- 
imals in order to determine the pathogenic char- 
acter of the inoculated material. 
Diagnostic inoculations are of particular value in the 
infectious diseases which follow. 

I. Tuberculosis. 

Tuberculosis can be recognized in only a small per cent, 
of affected animals by the use of ordinary clinical methods. 

On the one hand only a few symptoms' can be determined, 
on the other hand these symptoms are not characteristic be- 
cause they also occur in other diseases. The discovery of the 
tubercle bacillus as the cause of tuberculosis is hardly of any 
value in the clinical diagnosis of the disease in animals. Mor- 
bid products from an affected organ (lung of cow) for micro- 
scopical examination, are difficult to obtain; the quantity is 
small and besides is swallowed by the animal as soon as it 
reaches the pharynx. But. an opportunity to examine patho- 
logical nasal secretions, ejections, vaginal discharges or patho- 
logically altered milk must never be neglected. (See p. 94.) 

Under these circumstances the experimental de- 
termination of this disease is of great impor- 
tance. For this purpose we resort to the tuberculin 
test and to the inoculation of small experimental 
animals. 

The tuberculin test. Tuberculin is the toxin of the 
tubercle bacilli, obtained from artificial cultures of the same. 
The tubercle bacilli are cultivated for six weeks in 5% glycer- 
ine beef bouillon at 38° C. [100.4° F.] The culture is then 
sterilized at 110°G [230° F.] and filtered through unglazed 
porcelain tubes. The filtrate is evaporated to one-tenth its 
volume and thus constitutes tuberculin. After these manipu- 
lations the tuberculin is absolutely free from germs and there- 
fore it could never produce tuberculosis. Furthermore, it has 
no permanent injurious influence on either sick or healthy an- 



220 CLINICAL DIAGNOSTICS. 

imals ; during the tuberculin test the quality of the milk 
is in no way affected, but the quantity may suffer to 
the extent of a reduction of 10% or less, for a few days. In 
cattle with very advanced tuberculosis the disease has been ob- 
served to have become aggravated — according to reports. 

Dose.* The tuberculin prepared as above described is 
diluted with 9 volumes of water to which l / 2 % oi carbolic 
acid has been added. Cattle and horses receive 5 cc of this 
solution, yearlings 2.5 cc, calves 1 cc and dogs 0.5 — lcc. 

Technique. The tuberculin is injected subcutane- 
ously at the neck or in front of the shoulder. Before and 
after using, the hypodermic syringe should be disinfected with 
a 2% solution of carbolic acid. Before inserting the hypo- 
dermic needle smooth down the hair at the point of injection. 
Disinfection of the injected area is not necessary if care is 
exercised otherwise. The best time for injection is in the 
evening between 9 and 10 o'clock. The bodily temperature of 
the animal to be injected should have been ascertained at noon 
of the day of injection and also just before injection. Eight 
or nine hours after injection of the tuberculin, hence at 6 A. 
M., next day, the temperature of each animal should again be 
taken, and thereafter every two hours until the 18th hour 
after injection. Perhaps it is unnecessary to state that the 
temperatures should be recorded. 

Interpretation of Results. In tuberculous animals the 
injection of tuberculin produces fever (reaction), healthy an- 
imals are not affected. 

a. Cattle with pre-injection temperatures not exceeding 
39.5° C. [103.1° F.j and post-injection temperatures exceed- 
ing 39.5° C. [103.1° F.], providing the difference between 
the highest pre-injection temperature and the highest post-in- 

[This applies, of course, to the German tuberculin. In America the article is man- 
ufactured by a number of reliable firms. It should always be used as fresh as possible 
and the dose regulated according to the strength of the material. This is always indi- 
cated in the "directions for use."] 



DIAGNOSTIC INOCULATION. 221 

jection temperature is at least 1° C. [1.8° F.] are regarded as 
tuberculous. 

b. In calves under 6 montbs of age a rise of temperature 
exceeding 40° C. (104° F.) after injection of tbe tuberculin, 
provided the difference between the highest pre- and post- 
injuction temperatures is at least 1° C. (1.8° F.) indicates 
the existence of tuberculosis. 

The International Veterinary Congress of Budapest has 
accepted the following interpretation of the results of a tuber- 
culin test: 

1. A post-injection temperature exceeding 40° C. [10-4° 
F.], provided the temperature at the time of injection did not 
exceed 39.5° C. (103.1° F.), is to be regarded as a positive 
reaction. 

If the pre-injection temperatures of cattle exceed 39.5° C. 
C. [103.1° F.] and 40° C. [104.0°F.] the results are to be 
regarded as doubtful and to be considered upon their own 
merits. 

If the pre-injection temperatures of cattle exceed 39 :5° C. 
[103.1° F.], or if those of calves less than six months of age 
exceed 40° C. [104.0° F.], the tuberculin test should be made 
at a later date. 

Reliability. The tuberculin test cannot be regarded 
as absolutely infallible. About 90% of the tuberculous ani- 
mals give a reaction. Animals in advanced stages of the dis- 
ease frequently do not react. As a rule, however, a physical 
examination of such animals reveals symptoms which, when 
considered alone, would at least awaken suspicion as to the 
existence of the disease. Only a small per cent, of the react- 
ing animals is found to be free from tuberculosis. X e v e r - 
theless, tuberculin is the best diagnos- 
tic u m in our possession. 

Inoculation of experimental animals. The milk of 
tuberculous cows contains tubercle bacilli when the udder is 
affected with tubercular processes, and also in some cases 



222 CLINICAL DIAGNOSTICS. 

where tubercular processes in this organ seem to be absent. 
Microscopical examination of milk for tubercle bacilli is very 
difficult and the results unreliable, therefore we resort to 
intraperitoneal inoculation of Guinea pigs with the fresh milk 
of a suspected animal. If tubercle bacilli are contained in 
the milk tubercular nodules will develop on the peritoneum 
(omentum), spleen and liver in the course of two weeks. If 
the Guinea pigs do not die before, they are killed at the end 
of six weeks and carefully examined for tuberculosis. 

II. Glanders. 

In view of the great infectiousness and incurability of 
glanders, the object of the veterinarian is to determine the 
presence or absence of this disease at the earliest possible 
date. However, horses affected with glanders show no symp- 
toms or at least no characteristic symptoms in the early stages 
of the disease ; for this reason horses that have been 
exposed to an infection with glanders 
are subjected to a mallein test, with the 
object of thus enabling us to recognize the disease. If the 
animals show symptoms of the disease we endeavor to obtain 
some of the pathological products or secretions and with them 
inoculate experimental animals which are known from experi- 
ence to be susceptible to the disease and develop it in a char- 
acteristic form. 

Mallein inoculation. Mallein is the toxin of the bacilli 
of glanders and is obtained from their cultures in a manner 
analogous to that 'employed for obtaining tuberculin. The 
crude preparation is a fluid, obtainable from the manufacturer 
and injected in doses designated. It may also be obtained in 
the dry or powdered form and is thus injected in doses of 0.02 
— 0.1 G. according to the weight of the animal. It is best 
to have the solution of the dry tuberculin prepared by the 
manufacturer. 



DIAGNOSTIC INOCULATION. 223 

Technique. This is the same as for tuberculin inocu- 
lation. Taking temperature of animal to be tested, two or 
three times at definite intervals before inoculation ; inoculation 
between 10-12 P. M., and taking temperatures again on next 
day beginning at 5 A. M., and repeating every two hours until 
6 P. M. 

Interpretation of Results. The International Veterin- 
ary Congress has accepted the following principles for guid- 
ance in interpreting the results of a mallein test: 

1. A positive reaction to mallein confirms the diagno- 
sis of glanders only when it possesses a typical character. 

2. A typical reaction .consists of an elevation of temper- 
ature,, of at least twp degrees centigrade [3.8° F.] and must 
exceed 40° C. [104° F.] The temperature curve usually re- 
mains at an elevation for some time or it may make a slight 
drop and rise again on the same day. On the second, and 
sometimes on the third day, there will be more or less eleva- 
tion of temperature. A local as well as a general or con- 
stitutional reaction is also observed. 

3. Elevations of temperature less than 40° C. [104° F.], 
as well as greater elevations of an atypical character require 
re-testing of the animal. 

4. Gradually attained high temperatures of considerable 
duration, even if not typical, indicate the existence of glanders. 

5. A local typical infiltration of the tissues at the point 
of inoculation is a positive indication of the existence of 
glanders, even in cases where no thermal or general organic 
reaction occurs. 

6. All malleinized animals, whether they react or not, 
must be subjected to the mallein test twice, at intervals of ten . 
to twenty days. 

The results of the mallein test cannot be compared with 
those of the tuberculin test ; they are less reliable. There is 
no doubt that the varying- results obtained from the use of 



224 CLINICAL DIAGNOSTICS. 

mallein are due to differences in the character of the mallein 
used. 

Inoculation of experimental animals. A male Guinea 
pig is inoculated subcutaneously at the abdomen with nasal 
secretion, pus. etc., from a suspicious subject. If the inocu- 
lated material contains the bacilli of glanders a local abscess 
will develop at the point of inoculation and a firm hot swelling 
appear in the region of the thigh. After 2-4 weeks the 
Guinea pig is killed with chloroform. The presence of the 
characteristic nodules, etc., of glanders, in the region of the 
point of inoculation and in the testicles confirms the diagnosis. 
The method of Strauss, consisting of the intra-peri- 
toneal inoculation of male Guinea pigs, is of more recent intro- 
duction. With a cotton swab dip up some of the suspicious 
material from an ulcer or from nasal secretion, rinse in a few 
cubic centimeters of sterilized water, and inject one or two 
cubic centimeters of this fluid into the abdominal cavity of each 
of several Guinea pigs. If the inoculated material contained 
the bacilli of glanders, reddening and swelling of the scrotum 
and adhesion of the testicles will occur in the course of two 
or three days. More or less isolated pus centers develop on 
the tunica vaginalis and cause an adhesion of the peritoneal 
folds. Sometimes a single center at the point of inoculation, 
constitutes the only lesion. The danger of a general septic 
infection, from the impure material, may be obviated by keep- 
ing the infected swabs in a refrigerator for a few days. Pota- 
to cultures should always be made from the lesions of the 
scrotum. The true glanders bacillus produces yellow colonies 
resembling honey in color, while the pseudobacillus of glan- 
ders (Kutscher) produces white colonies. 

Cats, also, are suitable animals for inoculation. They are 
inoculated at the back of the neck. 

Serum Diagnosis of Glanders. (Agglutination Test). 
Scientific investigation has shown that bacteria suspended in 
fine emulsion, when acted upon by their respective immuno- 



DIAGNOSTIC INOCULATION. 225 

toxins (serums) become agglutinated (clumped) and sink 
to the bottom of the liquid in which they were suspended. 
This knowledge has also been made use of in the diagnosis of 
glanders. The technique, according to Schuetz, is as follows : 

Disinfect the skin overlying the jugular vein of the sus- 
pected horse, insert a hypodermic needle and withdraw about 
30 to 50 cc of blood into a sterilized flask, then seal care- 
fully. The serum is allowed to separate and is then diluted 
to various strengths by the addition of a physiological salt 
solution. 

The test fluid is prepared from virulent cultures of 
glanders bacilli that have been heated in a thermostat for two 
hours at a temperature of 60° C. [140° F.] in order to kill 
the bacteria. To this material is added a sufficient quantity 
of carbolized sodium chloride solution to make an emulsion 
which, in reflected light, has a slightly milky appearance. 

Two cubic centimeters of the test fluid are added to vary- 
ing proportions of the blood serum of the suspected horse 
and kept in a thermostat at 30° C. [86° F.] for from 24 to 30 
hours. If the serum agglutinates the bacilli when diluted in 
the proportion of 1 :1000, or more, the horse from which it 
was obtained is regarded as glandered. An agglutination re- 
sulting from a dilution of the serum of 1:500 to 1:1000 indi- 
cates probable infection, and an agglutination power of less 
than 1.500 indicates the absence of infection. The making of 
a successful agglutination test requires not only fresh and 
virulent cultures of glanders bacilli, but also a certain degree 
of skill and the necessary experience. For this reason it can 
be successfully performed in bacteriological laboratories only. 
The function of the practicing veterinarian, therefore, should 
be limited to the collection of the serum from the suspected 
animal which should then be forwarded to the proper state 
authorities, board of live stock commissioners or board of 
health. 



226 CLINICAL DIAGNOSTICS. 

III. Anthrax, Blackleg, Malignant Oedema and Wild-und 
Rinder-seuche. 

On account of their rapid course, the clinical diagnosis 
of these diseases is often impossible ; besides, the symptoms of 
the different diseases are often much alike and hence a dif- 
ferentiation impossible. Although a microscopical examination 
of the blood (or exudate) of animals that died of one of these 
diseases suffices to recognize their character by finding the 
characteristic organisms, still there are cases where an inocu- 
lation alone can decide the question. We use rabbits for this 
purpose and inoculate them cutaneously (!) in the ear, with 
blood or exudate from the animal or carcass in question. If 
the rabbit dies the disease is either anthrax or Wildseuche 
because blackleg and malignant oedema are not transmissible 
by means of cutaneous inoculation. The differentiation 
between anthrax and Wildseuche is made by a bacterioscopic 
examination of the dead rabbit. It is also worthy of note that 
in Wildseuche there is always a severe tracheitis. 

In case the rabbit does not die, it is 
again inoculated ; this time subcutaneously; if death 
follows, it was a case of malignant oedema because rabbits are 
immune against blackleg. The presence of blackleg can be 
demonstrated by inoculating a Guinea pig with the suspected 
material ; death following in a few days after inoculation. 

We can expedite matters by simultaneously inoculating 
one rabbit cutaneously and another rabbit and a Guinea pig 
subcutaneously. If all three animals die we had anthrax (or 
Wildseuche) if only the two subcutaneously inoculated ani- 
mals die it was a case of malignant oedema, and in case it was 
blackleg only one animal, the Guinea pig, is sacrificed. 

*If we desire additional proof by having the blood of a 
suspected anthrax carcass examined by a second person we 
may boil a potato, upon cooling cut it in halves with a steri- 

* [This method is commonly resorted to in Germany.] 



DIAGNOSTIC INOCULATION. 22? 

lized (flamed) knife, apply some of the suspected material to 
the surface of one half, replace the other half, pack carefully 
and send it to the official bacteriologist. Blood sent in a flask,. 
is usually not adapted for microscopical examination. 

IV. Rabies. 

Suspected dogs are usually killed before they can be sub- 
jected to examination by an expert. A post mortem examina- 
tion will then hardly enable us to make a definite positive 
diagnosis ; we must resort to inoculation of a test animal. 
The diagnostic inoculation of a rabbit 
with the brain matter ofa suspected dog 
is the only absolutely safe method of 
definitely determining the presence of 
rabies. 

Technique. The brain and cervical cord of the sus- 
pected dog are carefully removed. The medulla oblongata is 
severed from the brain by an incision, at the pons Varolii, 
made with a "flamed" knife. A piece of the medulla (size of 
a pea) is removed with sterilized scissors from the cut surface, 
placed into a sterilized porcelain vessel and thoroughly tritu- 
rated with a small quantity of distilled water. This emulsion 
is used for inoculation. 

1. The Intra-ocular method according to Johne. Two 
rabbits are inoculated, each receiving a few drops of the emul- 
sion into the anterior chamber of the eye ; injected with a ster- 
ilized hypodermic syringe. If the hypodermic needle is fine 
and sharp and the rabbit's eye has been previously dis- 
infected and anesthetized the operation can be per- 
formed with little difficulty. We insert the needle at the bor- 
der of the cornea, directing it toward the median line. If the 
operation was carefully conducted a slight turbidity of the 
cornea, which soon disappears, is the only symptom that fol- 
lows. 



228 CLINICAL DIAGNOSTICS. 

If rabies is present the first symptoms appear in from 2 
weeks to 23 days ; the animals are shy, crawl away, and show 
loss of appetite. After 12 hours paralysis and difficult deglu- 
tition is observed, the animals emaciate rapidly, grit their teeth 
and emit a cry when touched on the head. The disease, thus 
produced, terminates fatally within 48 hours. 

2. Subdural Inoculation. Carefully trephine the 
frontal bone of a rabbit, observing the necessary antiseptic 
and anatomical precautions. By means of a sterilized glass 
syringe having its nozzle bent at right angles, inject a few 
drops of the emulsion under the duramater, stitch the wound 
and protect with collodion, or absorbent cotton. 

If the inoculation material is fresh and virulent, death 
will follow in two or three weeks. Sometimes the animals 
die as early as the 11th day, or may live until the 30th day. 
[In some cases six weeks will elapse before the first symptoms 
of the disease can be observed.] 

3. Intra-muscular Inoculation. If the suspected nerve 
tissue has begun to decompose, or if suspicion exists that it 
may not be fresh, it should be immersed in a one-half per cent, 
solution of carbolic acid and placed in the refrigerator for 24 
hours. It is then removed and carefully triturated with 
beef broth until a fine emulsion results. Rabbits receive from 
three to five cubic centimeters of this emulsion injected into 
the dorsal muscles in the region of the loins. As a rule septic 
infection can be avoided in this way while the virulence of 
the material is otherwise unaffected. Death follows after two 
or three weeks or somewhat later. 

The symptoms following subdural and intra-muscular in- 
oculation are much the same. After ten or twelve days ema- 
ciation sets in, followed by paralysis of the hind parts, and 
death two or three days later. 

4. Subconjunctival Inoculation. This is recom- 
mended by Szpilman as easy of execution and certain in its 
results. 



THE LYMPHATIC GLANDS. 229 

In the "Tollwuthabteilung of the Institut fuer Infections- 

krankheiten," in Berlin, the subdural and the intra-muscular 

inoculations are used exclusively, sometimes both methods are 

used at the same time. (Eieck). 

Differential diag,n:sis. Beck calls attention to the fact that 
material obtained from clogs affected with the nervous form of dis- 
temper will produce paralysis of the hind parts of rabbits that have 
been inoculated. In these cases the paralysis is not confined to 
the posterior extremities, but extends to the bladder and rectum 
Rabbits thus affected become soiled witli feces and urine. This 
affection cannot be transmitted to a second generation of rabbits. 

14. The Lymphatic Glands. 

The intermaxillary lymphatic glands of horses are always 
subjected to an examination in diseases of the respirator}- ap- 
paratus. Otherwise they are subjected to s p e c i a 1 exam- 
inations only when infectious diseases, glanders and 
tuberculosis, constitutional blood diseases (leuce- 
m i a ) or the presence of malignant tumors ( carcinoma 
and sarco m a ) are suspected. Examination consists in 
palpation (conducted according to the rules given on p. "ill. 
The correct interpretation of these changes was discussed 
under "intermaxillary lymphatic glands." 

When an examination i^ called for, the following lym- 
phatic glands must be considered: 

1. Inter m axilla r y 1 y m p h a t i c g 1 a n d s . 1 y m - 
p h o - g 1 a n d u 1 a s u b m axillaris. In the ox these are of 
the size of half a walnut and are situated on the median side of the 
submaxilla, near its border and in the region of the point of in- 
sertion of the muse, sterno-maxillaris. 

2. L y m p h a t i c g 1 a n d s o f the parotid region, 
1 y m p h o g 1 a n d u 1 a p a r o t i d e a e . These are between and 
below the lobules of the parotid gland. In the ox they have the 
shape of a flattened tongue and a length approaching 6cm.; this 
gland projects from beneath the border of the parotid gland, below 
the maxillary articulation. 

:;. T h e superior c e r v i c a 1 g 1 a n d s 1 y m p h o - 
g 1 a n d u 1 a cervlcales superiores, and retro- 
pharyngeales are situated, as the name implies, on the pos- 
terior wall of the pharynx. In the ox they consist of a closely 
united packet, about 5cm. long, under the lateral processes of the 
atlas, where they can be felt by placing the thumb on the lateral 



230 



CLINICAL DIAGNOSTICS. 



process of the atlas (both sides simultaneously) and thus pressing 
the finger tips behind the pharynx and then against the inferior 
face of the lateral processes of the atlas. 

4. In the ox a few large lymph follicles in the depression in 
front of the shoulder (prescapular glands) and on the 
chest in front of the elbow articulation (prepectoral 
glands). v 

Fig. 53. 








Lymph glands of the ox accessible by external palpation. 

5. The lymphatics of the shoulder (pre- 
scapular glands) are covered by the mastoido-humeralis 
muscle in front of the scapulo-humeral articulation. 

6. The p r e c r u r a 1 glands lie at the anterior border 
of the tensor fascia lata muscle; distinctly visible in cattle. 

7. In the upper part of the flank of the ox 
four or five follicles as large as a lentil can frequently be felt sub- 
cutaneously. 

8. The deep inguinal glands lie in the crural 
canal covering the crural vessels. 

f The superficial inguinal glands in the male 
animal at the neck of the scrotum on each side of the penis in the 
sheath. In the female as follows:] 

9. The retromammary glands (glands of the udder) 
are especially well developed in the cow and are situated behind 
and above the udder. 

10. The mesenteric, lumbar and sacral glands 
of the horse and cow can be examined per rectum. In the former 
the bowel should be evacuated by means of a cathartic; for the lat- 
ter it is at least advisable to do so. 



THE BLOOD. 



231 



In the healthy horse we can distinctly feel the intermax- 
illary glands, in the healthy ox the precrural glands, and no 
others-; if any of the other glands are distinctly palpa- 
ble we assume that they are enlarged. 

The intermaxillary lymphatic glands 
of the horse are sometimes extirpated in 
order to subject them to a special macroscopical, or microscop- 
ical and bacteriological examination. For diagnostic purposes 
we resort to it in glanders only. We operate on the standing 
animal and anesthetize according to Schleich's method. 

15. The Blood. 

The examination of the blood is of importance in a few 
rare cases only. A microscopical examination to determine 

Fig. 54. 




Leucemic Blood. 

the presence of certain infectious diseases is of value only in 
anthrax and Rothlauf in pigs, and even in these diseases the 
circulating blood contains only few organisms. However, i n 
Texas fever it is of diagnostic importance, and in con- 
stitutional blood diseases it is equally invaluable. 

The best way to obtain the necessary blood is to make a 
slight incision into the lip. with the point of a knife, observing 



232 CLINICAL DIAGNOSTICS. 

care not to stretch the skin during the operation. If a larger 
quantity of blood is desired a hypodermic needle, inserted into 
the jugular vein, answers the purpose better. [As far as an- 
noyance of the animal is concerned, tapping the jugular vein 
is preferable in all cases.] In practice we may limit our- 
selves to the microscopical examination ; for this purpose a 
single drop of blood, placed directly on the glass slip or cover, 
will serve the purpose. From this drop we can make a few 
cover glass preparations, allow them to dry, take them home, 
fix, stain and examine them at leisure; or we may add a 0.3% 
solution of sodium chloride and examine the blood in its fluid 
condition. Exact blood examinations are difficult and must be 
carried out with such care and minuteness that the practitioner 
is obliged to get al6ng with the results of the simplest meth- 
Fig-. 55. ods. For those who care to take 

ft V\ 4Sk C& U P ^ study of blood examinations 

A ^ O in detail we recommend "Jacksch- 

^N &/) & Klinische Diagnostik." 



s\ £? £) /-£. Number of blood corpuscles. 

^ puscles in a given amount of blood 



yfcf) ® () f) ^ The absolute number of blood cor 

r\^/v ,-5 ^> puscles in a given amount of blooa 

^^ <^n ® ^ can on ty ^ e determined with the 

Abnormal Forms of Red aid of special blood-counting appa- 

Corpuscies. ratus (Thoma-Zeiss) . According 

to the investigations of Storch, the number and proportion of 

red and white corpuscles per cubic millimeter are as follows : 

Red Corpuscles. White Corpuscles. Proportion. 



Stallions 


8.2 


millions 


10,500 


1:780 


Geldings 


7.6 


•■ 


11,000 


1:690 


Mares 


7.1 


." 


9,900 


1:720 


Colts 


. {):.) 


« 


14,000 


1:670 


Bulls 


6.5 


<< 


7,800 


1:820 


Steers 


6.7 


a 


9,400 


1 :720 


Cows 


5.5 


u 


8,200 


1:660 


Calves 


8.5 


i. 


15,700 


1:550 


Dogs 


5.4 


ti 


3,100-2,800 






THE BLOOD. 233 

Since the results of these investigations show that con- 
siderable variations occur under normal conditions, extreme 
variations alone can be regarded as being of importance. 

An increase in the number of red corpuscles has been 
observed in serious general diseases with fatal termination: 
pulmonary gangrene, angina, pleuro-pneumonia. 

A decrease in the number of erythrocytes occurs in essen- 
tial anemia, hydremia, leukemia, and particularly in per- 
nicious anemia. 

Shape of the red blood corpuscles. We usually group 
them as follows : 

1. Normal red corpuscles, without nucleus. 

2. Nucleated erythrocytes. 

a. Normoblasts of normal size. 

b. Megaloblasts, two or three times the size of nor- 

mal red corpuscles. 

c. Gigantoblasts, still larger than the megaloblasts. 

d. Microblasts. smaller than the normoblasts. 
When the normal blood corpuscles deviate from their 

usual biconcave form they are called poikilocytes. Similarly 
altered nucleated red corpuscles are called poikiloblasts. 

The red corpuscles frequently undergo considerable 
change in form in the course of preparation for microscopic 
examination. This must always be borne in mind when dif- 
ferentiating between the different groups. 

Varieties of the white corpuscles. According to Ehr- 
lich and his pupils the white corpuscles are classified as fol- 
lows : 

1. Lymphocytes. These are from 6 to 9 micra in diam- 
eter, with a single, large, well-defined nucleus containing an 
abundance of chromatin. They stain with basic aniline 
dyes, the protoplasm absorbing more of the stain than the 
nucleus. 

2. Large Mononuclear Leucocytes. These are 12 to 
15 micra in diameter, contain a large, not well-defined sin- 
gle nucleus with little chromatin, and homogeneous, baso- 
phile protoplasm. 



234 CLINICAL DIAGNOSTICS. 

Transition forms occupy a position between the large 
mononuclear leucocytes and the polynuclear leucocytes, their 
nucleus being - divided into two or three sections. They resem- 
ble the mononuclears in their affinity for stains. 

3. Polynuclear Leucocytes. These are 10 to 12 micra 
in diameter, are provided with a slender but broken and 
irregular nucleus containing an abundance of chromatin and 
a finely granular, opaque, neutrophile protoplasm. 

4. Eosinophile Leucocytes. These are 12 to 15 micra 
in diameter, the body of the cell is filled with large roundish 
granules which have an exceptional affinity for eosin and other 
acid stains. They have one or two nuclei which are packed in 
between the granules. The nuclei contain an abundance of 
chromatin. 

5. Mast Cells. These vary in size up to that of the eosin- 
ophyles, they have clumsy nuclei of various forms containing 
little chromatin, and basophyle, coarsely granular protoplasm. 

According to Wiendick the varieties of leucocytes occur 
in the following proportions in the blood of the horse : 

Actual No. 

per cubic 

Percentage, centimeter. 

1. Lymphocytes 35-45 2500-3500 

2. Mononuclear Leucocvtes 1.5-3.5. . . .150-300 

3. Neutrophyle Polvnuclear Leucocvtes 50-70 4000-5000 

4.' Acidophvle Leucocvtes '. . . .1.5-5.0 200-350 

5. Mast Cells (Basophyle leucocytes) . .0.2-0.7 20-60 

It is not unusual to observe even greater variations than 
those shown in the table. 

A temporary increase in the actual number of leucocytes 
(hyperleucocytosis) may occur after feeding and in animals 
in advanced .pregnancy. Such an increase is also observed in 
the course of all infectious inflammatory processes, especially 
during the formation of abscesses in the course of strangles. 
The actual number of leucocytes is reduced (hypoleucocy- 
tosis) permanently in the course of pernicious anemia. In 



THE BLOOD. 235 

this disease the relative proportion of red corpuscles is less 
than normal. 

The normal color of blood serum is a light golden 
yellow (straw color). After the destruction or breaking down 
of a large number of red corpuscles their coloring matter is 
dissolved in the plasma of the blood and is partially converted 
into methemoglobin. This causes a reddening of the serum 
(Hemoglobinemia). The presence of the coloring matter of 
the muscles may produce a similar result. 

Diseases of the Blood. 

Essential (idiopathic) anemia. Bloodlessness. Consists in a 
diminishment of the quantity of blood without a determinable 
cause. Blood pale and coagulates poorly. Mucous membranes 
pale and low temperature. Pulse small, heart tones metallic 
sound. Appetite poor. Tendency to dropsical swellings. General 
weakness. Mostly in young animals. 

Pernicious anemia. Primary anemia of adult animals with 
fatal termination. Fever not constant. Mucous membranes pale 
and somewhat yellowish. Pulse gradually becoming more rapid, 
appetite less and less. Increased weakness terminating in death. 
Blood watery, changes in red corpuscles characteristic: usually 
large ones with nuclei, and small irregular forms, seem elongated, 
angular or toothed, club or pear shaped. 

Leucemia. Chronic alterations of the blood and increase in 
number of white corpuscles. Animals are languid, lazy, sweat 
easily, pale mucous membranes. Appetite grows less, pulse in- 
creases, small. Heart tones, metallic sound. Enlargement of lym- 
phatic glands usually present. Sometimes ecchymotic hemor- 
rhages in the mucous membranes. 

Hemoglobinuria of cattle. An acute non-contagious infec- 
tious disease of cattle caused by the presence of the protozoon 
Pyroplasma bigeminum in the blood, and characterized by hemo- 
globinuria. About 12 days after the animals have been on an in- 
fected pasture, the first symptoms appear — fever, loss of appetite, 
diarrhea. Urine light to dark red, very foamy, urination painful. 
Urine contains hemoglobin and coagulates into a gelatinous mass 
when boiled. Gait stiff and clumsy, often attended with pain. 
Also anemia, icterus, general debility, continuous lying down, 
edematous swelling of head and neck. 

The cause of the disease is found in the blood in the form of 
a protozoon called Pyroplasma bigeminum. The latter has a 
roundish form which may become very irregular as a result of 
ameboid movement. 

When fully developed they are found in the red corpuscles in 
the form of two pear shaped bodies with the narrow ends ap- 



236 CLINICAL DIAGNOSTICS. 

proaching each other, or in actual contact. They are 2.5-4 micra 
long and 1.5 to 2 micra wide. Two per cent, of the red corpuscles 
in the circulating blood are infected, while 50% of the red corpus- 
cles of the capillaries of the organs contain the parasites. 

The presence of the parasites is easily demonstrated by fixing 
smear preparations in absolute alcohol and staining with alkaline 
methylene blue. 

Texas Fever. Is an infectious disease of cattle caused by 
Pyrosoma bigeminum [indirectly by the presence of Texas fever 
ticks, Boophilus bovis]. Period of incubation 10-15 days. High 
and continuous fever, rapidly progressing anemia, red corpuscles 
reduced in number from six- million to one million per cc. Hema- 
globinuria. Fatal termination the rule. 

Pyrosoma bigeminum is a minute pale protozoon of 
a roundish form found in the red corpuscles. It possesses ame- 
boid movement and can therefore assume irregular shapes. When 
fully developed the parasites occur as two pear-shaped bodies with 

Fig. 56. 




Different stages of development of Pyrosoma bigeminum in red blood corpuscles. 



their pointed ends, converging. They are 2.5 to 4 micra long and 
1.5 to 2 micra wide. In the circulating blood 1 to 2% of the blood 
corpuscles are infected, in the capillaries of the various organs 
more than half of them contain the parasites. 

Malaria A non-contagious infectious disease caused by Plas- 
modium malariae. Remittent fever, pronounced icterus, petechiae, 
cerebral depression, small rapid pulse. Loss of appetite, increased 
thirst, dark-colored urine staining white hair yellow. The malaria 
parasites which occur in the blood constitute a special group of 
protozoons. They differ from the Pyrosoma in being pigmented. 
They may be stained with methylene blue. They are bright 
roundish bodies with distinct outline, occurring singly in the red 
blood corpuscles. 

Flagellosis of horses. Mai de Caderas. Gradually rising re- 
current fever rarely exceeding 40° C. (104° F.) Rapid emaciation 
in spite of good appetite. Paralysis of the hind quarters, bladder 
and rectum. Edema, hemoglobinuria, continuous lying down, 
coma, death. The specific cause of the disease, Trypanosoma 
equina (Flagellata) is found in the blood as an actively motile 
parasite. Smear preparations may be stained in 15-20 minutes 
with carbol-fuchsin to which has been added one-third volume of 
glycerine. Magenta red, however, is a better stain. The parasite 
has the form of a whip lash and is three or four times the length 

[Malkmus regards this disease and hemoglobinuria of cattle (Europe) as very proba- 
bly identical.]— Translators. 



THE BLOOD. 



337 



of the diameter of a red blood corpuscle. The convex border of 
the body contains a delicate membrane which extends to the end 
of the body, forming a tail. The body of the parasite contains 
bright round granules which do not take the stain. Very destruc- 
tive in South America. 

Fig. 57. 




Nagana, Tsetse Disease, Surra. Occurs in cattle, solidungula, 
camels, dogs and cats. This is a pernicious anemia caused by 
Trypanosoma Evansi (introduced into the tissues through the me- 
dium of the tsetse fly). Fever, muscular weakness, edema, affec- 
tion of the eyes, pronounced anemia. A flaggellate parasite, like 
the above, 20 to 40 micra long, 1 to 2.5 micra in diameter, actively 
motile. 



INDEX. 



Abdomen, 133, 145. 

Abnormal sensitiveness 149. 

Accumulation of food 146, 
154. 

Achorion Schoenleinii, see 
Favus 54. 

Acne contagiosa equor, see 
Canadian horsepox 56. 

Actinomycoma 142. 

Actinomycosis 136. 

Albuminuria 66, 174, 176. 

Albumosuria 177. 

Alkalies, craving- for 135. 

Alopecia 44, 50. 

Alveolar periostitis 137. 

Anemia 48, 59, 235. 

— , pernicious 235. 

Anesthesia 202. 

Anamnesis 18. 

Anasarca 47. 

Angina pharyngea 164. 

Ante-and post-partum pare- 
sis 37. 

Anthrax 71, 226. 

Anus 99. 

Apoplexy 205, 208. 

Appetite 134. 

Arteries 79. 

Ascites 40. 

Ascarides 61. 

Atelectasis 27, 122. 

Attitude 33. 

Auscultation 29. 

— of abdomen 154. 

—of heart 83. 

— of lungs 124. 

Azoturia 37, 41. 



Bacillus pvelonephritis 189. 

Balkiness 183. 

Bird lice 51. 

Blackleg 57. 

Bladder, diseases of 167. 

— , examination of 190. 

Blind staggers 207, 209. 

Blood 231, 232. 

Blood sweating, 50. 

Blowing sound 94, 100. 

Bodily temperature 62. 

Bovine pest 57. 

Broken back 37. 

Bronchial catarrh 130. 

Bronchiectases 107, 123. 

Bronchitis 102, 130. 

— verminosa 130. 

Bruits, anemic 87. 

— , diastolic 85. 

— , inorganic 85. 

— , systolic 85. 

Cachexia 39. 
Canadian horsepox 56. 
Carbonate of lime 183. 
Cardiac dullness 83. 
Catarrh of maxillary sinuses 

129. 
Caverns in lungs 123. 
Cerebral congestion 207. 
— depression 200. 
— hemorrhage 208. 
Cerebrospinal meningitis 38, 

4?. 208. 
Chills QQ. 
Choleurea 180. 
Circulatory apparatus 73. 



239 



Coital exanthema 197. 
Colic 41, 157, 165. 
Collapse, temperature of 70. 
Colostral milk 195. 
Colpitis 197. 
Coma 200. 
Condition 38. 
Conformation 39. 
Congestion, cerebral 207. 
Conjunctiva 57. 
Constipation 155, 157, 166. 
Convulsions 202. 
Cough 111. 

— , return impulse of 114. 
Cracked pot resonance 123. 
Cramp of the neck 38, 42, 

203. 
Crisis 70. 
Crusts 50. 
Cystitis 191. 

Defecation 156, 157. 207. 
Deglutition, difficulties of 

" 138. 
Diabetes 171. 
— insipidus 192. 
— mellitus 192. 
Diaphragm, rupture of 124. 
Diarrhea 14 7. 157. 
Dicrotic pulse 79. 
Differential diagnosis 16. 
Digestive apparatus 133. 
Dilatation of the heart 88. 
Direct diagnosis 16. 
Dislocation of bowel 124, 

165. 
Distemper of dogs 133, 202, 

205. 
— of horses 132. 
Distoma, eggs of 162. 
Diverticula of esophagus 

143, 164. 



Dizziness 201, 207. 
Drowsiness 200. 
Dropsy 47. 

Dummies 31, 34, 207, 209. 
Dyspepsia 164 
Dyspnea 34, 96. 
Dysuria 170. 

Ecchymoses 10T, 108, 140. 

Echinococcus disease 131. 

Eclampsia "208. 

Eczema 50. 

Edema 23, 4;, 57. 

— of glottis 129. 

— collateral 48. 

Emphvsema 24, 49. 

— , alveolar 130. 

— , cutaneous 24, 48. 

— , interstitial 131. 

— , of skin 48. 

• — , septic 48. 

Encephalitis 34. 

Endocarditis, acute and 

chronic 88. 
Endometritis 197. 
Enteritis, hemorrhagic 160. 
Enteroliths 152. 
Epilepsy 203, 207, 216, ?17. 
Epithelial casts 189. 
—cells is;. 
Eructation 144. 
Esbach's albuminimeter 176. 
Esophagus 146. 
Excitability, abnormal 210. 
Exhalations 100. 
Expired air, odor of 100. 

Facies hypocratica 41. 
Facial nerve, paralysis of 

HI. 
Fagopyrism 50. 



240 



Fainting 201. 

Favus 54. 

Feces 156, 158. 

— , retention of 157. 

— , voiding of 157. 

— , volume of 158. 

Fermentation test 182. 

Fever 65, 67. 

— curve 67. 

— , types of 69. 

Fluctuation 24. 

Flagellosis 236. 

Fleas 51. 

Food, manner of taking 135. 

Foot and mouth disease 55. 

Foot eczema 51. 

Foreign bodies in intestines 

166. 
—in esophagus 164. 
Fowl cholera 72. 
Friction bruits of pleura 128. 

Garglings 96. 
Garget 197. 
Gastro-enteritis 165. 
Gastro-intestinal catarrh 

165. 
Glanders 132. 
— ulcer 94. 
— cicatrices 95. 
Gmelin's test ISO. 
Gram's method 189. 
Granular casts 189. 
Granule casts 188. 
Grape sugar 182. 
Groaning 96. 
Grunting 96. 
Guttie of ox 34, 165. 

Habitus 32. 
Hematopinus 52. 
Hair coat 43. 



— , shedding of 44. 

Heart 81. 

—beat 82. 

— sounds 84, 85. 

Heave line 99. 

Heaves 212. 

Hematuria 178, 191. 

Hemidrosis 45, 50. 

Hemiplegia 98. 

Hemiplegia, larvngis sinis- 
tra 129. 

Hemoglobinuria 178, 179, 
191, 235. 

Hepatization 27, 122. 

Herpes tonsurans 54. 

Hippuric acid 185. 

Hives 50. 

Hog cholera 71. 

Hyaline casts 188. 

Hydrocephalus 119, 203, 207. 

Hypesthesia 202. 

Hvperemia of kidneys, pass- 
ive 191. 

Hyperesthesia 202. 

Hyperidrosis 45. 

Hypertrophy of heart 88. 

Hypidrosis 45. 

Icterus 60, 61, 201. 

Immobility 209. 

Impaction of intestines 151. 

— , rectum 205. 

Incarceration 151. 

Incontinentia urinae 191. 

Indican 179. 

Influenza 71. 

Inoculation 218. 

— for anthrax, etc. 226. 

—for glanders 222. 

—for rabies 227. 

— for tuberculosis 219. 



241 



Insufficiency 86. 

■ — of mitral valves 89. 

— of semi-lunar valves 86, 

89. 
— of tricuspid valves 89. 
Intermaxillary lymph glands 

109. 
Intestinal catarrh 166. 
— evacuations 156. 
— gases 163. 
— noises or sounds 154. 
— peristalsis 156. 
Intoxication 19. 
Invagination 35, 152. 
Ischury 170. 

Kidneys, passive hvperemia 

of 191. 
Kyphosis 43*. 

Laryngeal catarrh 129. 

Laryngeal fremitus 117. 

Laryngitis, croupous 129. 

Laryngoscopy 116. 

Leucocytosis 234. 

Leucemia 235. 

Lice 51. 

Licking disease 166. 

Lime casts 163. 

Liver 163. 

Lockjaw 208, see tetanus. 

Loco weed poisoning 167. 

Lordosis 43. 

Louse flies 51. 

Lumbago 37, 41, see azotu- 

ria. 
Lungs, congestion of 130. 
— , gangrene of 130. 
— , edema of 130. 
Lupinosis 167. 
Lymphatic glands 229. 
Lysis 70. 



Mast cells 234. 

Macula 49. 

Mai de Cederas 236. 

Mai du co it 197. 

Malaria 236. 

Malignant catarrhal fever 
133. 

— carbuncle 48. 

— edema 57. 

Malingerers 36. 

Mallein inoculation 222. 

Malleus L32. 

Mange 53. 

— , acarns 54. 

— , psorbptic 53. 

— , sarcoptic 53. 

— , sarcoptic, of fowls 53. 

— , symbiotic 53. 

Mastication 134. 

Mastitis 197. 

Melanosarcoma 142. 

Microcytes 234. 

Milk fever, see parturient 
paresis 37. 

Mites 51. 

Mold poisoning, see mycosis. 

Monoplegia 205. 

Morbus maculosus, see pur- 
pura hemorrhagica. 

Motility 199, 202. 

Mouth cavity 139. 

Mouth speculum 141. 

Mycosis 140. 

Mydriasis 806. 
Mucous click 95. 
Muscular rheumatism 42. 
Muscular sense 204. 
Myocarditis, acute 88. 

Nagana 



242 



Nasal catarrh 129. 

— discharge 90. 

— mucous membrane 107. 

— tone, see mucous click 95. 

Nephritis 191. 

Nettle rash 56. 

Nervous system 197. 

Nodules, see papules 50, 108. 

Nymphomania 192. 

Obesity 39. 
Ocular vertigo 201. 
Estrus ovis, larva of 103. 
Opisthotonus 202. 
Orthotonus 202. 
Osteomalacea 43. 
Overfeeding 146, 149. 
Oxalate of lime 184. 

Palpation 23. 

— of bowels per rectum 149. 

Panting 94. 

Papules 50. 

Paraplegia 98, 205. 

Paralysis 204. 

—of bladder 170. 

— of facial nerve 208. 

—of the larynx 130. 

— of esophagus and pharynx 

138, 164. 
— of paunch -143. 
— of recurrent nerve 214. 
Parasites, intestinal 162. 
— in cavities of head 129. 
Paresis 204. 
Parturient paresis 37, 70, 

209. 
Pathognomic symptoms 14. 
Paunch, paresis of 149. 
— , peristalsis of 149. 
— , gases in 146. 
Pentastonum tenioides 103. 



Percussion 24. 
Percussion, field of 120. 
—of abdomen 152. 
Pericarditis 82„ 89. 
— , traumatic, of ox 90. 
Peritoneal hernia 152. 
Peritonitis 34, 166. 
Pernicous anemia 235. 
Petechia 107, 108, 1-10. 
Pharvngitis 142, 164. 
Pleuritis 34, 82, 131. 
Pleurodynia 34, 130. 
Pleuropneumonia of the ox 

133. 
—of the horse 131. 
Pneumonia 123. 
— , catarrhal 130. 
Pneumothorax 131. 
Poikilocytes 233. 
Polyarthritis 42. 
Priapism 192. 
Proctitis 140. 
Prurigo 208, 50. 
Pseudo fluctuation 24. 
Psychic functions 199. 
Ptyalism 163. 
Pulmonary, congestion and 

edema 130. 
— gangrene 101, 126, 130. 
— -resonance 122. 
Pulse 66, 73. 
Pumping of flanks 99. 
Purpura hemorrhagica 56, 

109. 
Pustules 50. 
Pyemia 70. 
Pyelonephritis 191. 
Pyrosoma bigeminum 236. 
Pyrocatechin in horse urine 

182. 



243 



Quality of percussion 

sounds 26. 
Quibbing 137. 

Rabies 205, 208. 

Rachitis 42, 43. 

Rales 127. 

— , crepitant 127. 

— , dry, 128. 

— , moist 127. 

Reflex excitability 206. 

Reflex spasm? 203. 

Regions of the body 21. 

Regurgitation 120, 125. 

Resistance in percussion 28. 

Respiration, types of 94. 

— , amphoric 126 

— , bronchial 126. 

— , vague or indefinite 126. 

— , vesicular 124. 

Respiratory apparatus 90. 

Retentio uranae 191. 

Return impulse 114. 

Riding school movements 

203. 
Rinderpest 167. 
Rinderseuche 226. 
Ringworm 54. 
Risus sardonicus 203. 
Roaring 98, 129, 214. 
Rothlauf 201, 231. 
Rumination 143. 

Saliva, secretion of 140. 
Satyriasis 192. 
Saw-horse attitude 34, 203. 
Scabs 50. 
Scalma 131. 
Sensibility 199, 201. 
Septicemia 70. 
Sexual apparatus 192. 
— desire 192. 



Sheep pox 55. 

Signalment 31. 

Skin 43. 

— , color of 45. 

— , exhalations of the 46. 

— , moisture of 44. 

— , odors of 46. 

— , reflexes of 206. 

— , sclerosis of 46. 

Skoliosis 43. 

Sleepiness 200. 

Sneezing !)(>. 

Snoring 95. 

Snorting 94. 

Somnolencv 200. 

Sopor 200. 

Spasms 2<>2. 

Spinal paralysis 37, 205. 

Spinal meningitis 203. 

— , reflexes 206. 

Spine, fracture of 37, 205. 

Spleen 163. 

Stasis 47. 

Starvation 147. 

Stenosis of air passages 214. 

— of cardiac valves 86. 

— of esophagus 164. 

Stenotic laryngeal tone 95. 

Stethoscope 29. 

Stomacace 140. 

Stomatitis 163. 

— pustulosa contagiosa 167. 

Strangles 132, see distemper. 

Stranguria 169. 

Strongylus filaria 130. 

Submaxillary lymph glands 

90, 109. 
Suffusions I os. 
Sulphate of lime 186. 
Summer surfeit 50. 
Surra 2:1 1. 
Sweating 44, 45. 



244 



Sweeny 49. 
Swine erysipelas 46. 
Swine plague 64, 71. 
Symptoms 12. 
Syncope 201. 

Teeth 140. 

— . caries of 101. 

— , diseases of 164. 

; — , gnashing of the 137. 

Temperament 40. 

Tetanus 37, 208. 

Texas fever 72, 231, 236. 

Thirst, see "Desire for water 

p. 134. 
Ticks 51. 

Torsion of colon 152. 
Torsio uteri 196. 
Trembling 202. 
Trichodectes 52. 
Tricophyton tonsurans 54. 
Triple phosphate 186. 
Trismus 202. 
Trommer's test 182. 
Tubercle bacilli 105, 106. 
Tuberculin test 219. 
Tuberculosis 131. 193. 
Tumors in cavities of head 

129. 
Turnsick 201, 203, 208. 
Tympanitis 165. 
—acuta 144, 165. 
— chronica 144, 165. 
Tzetse disease 237. 

Udder 194, 196. 

Ulcers 140. 

■ — catarrhal or erosion 108. 



Upper air passages 106. 
Uremia 201. 
.Urethral calculi 190. 
Uric acid 185. 
Urinary apparatus 167, 
— casts' 188. 
Urination 167. 
Urine, sediment in 184. 
— , voiding of 167. 
Urticaria 56. 

Vaginal mucous membrane 

194. 
Vaginitis 197. 
Valvular diseases 88. 
Veins 80. 

— , undulation of jugular 80. 
Venous pulse 81. 
Verminous bronchitis 130. 
Vertigo, 201, 216, 217. 
Vesicles 50. 

Vesicular eruption 193, 197. 
Vesicular murmur 124. 
— respiration 125. 
Voice, change in 115. 
Vomiting 144. 
— in horses 144. 

Water, desire for 134. 
Whistling 9(r, 215. / 
Woody tongue 136. 
Wool eating 151. 
Wool in feces 162. 
Wheezing - 94. 

Wild-und Rinder-seuche 57, 
226. 

Yawn 94. 



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